促肾上腺皮质激素刺激在肾上腺静脉采血中的应用价值评估  

Adrenocorticotrophic hormone stimulation in adrenal vein sampling

作　　者：王怡洁 曾阳杰 刘梦思 陈焕 楼媛 田朝阳 张子为[2] 李平[1,2] Wang Yijie;Zeng Yangjie;Liu Mengsi;Chen Huan;Lou Yuan;Tian Zhaoyang;Zhang Ziwei;Li Ping(Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Department of Endocrinology,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China;Department of Endocrinology,Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School,National Clinical Medical Research Center for Metabolic Diseases,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院,南京大学医学院附属鼓楼医院内分泌科,210008 [2]南京大学医学院附属鼓楼医院内分泌科,国家代谢性疾病临床医学研究中心分中心,210008

出　　处：《中华内分泌代谢杂志》2022年第11期957-962,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家重点研发计划(2021YFC2501600,2021YFC2501603)。

摘　　要：目的探讨促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)刺激在肾上静脉采血(adrenal vein sampling,AVS)中的应用及对于采血成功率及优势分泌判定的影响。方法回顾性收集2018年7月至2020年6月至南京鼓楼医院就诊确诊原发性醛固酮增多症并行AVS的54例患者的临床资料。所有患者均在基础及ACTH刺激后进行双侧肾上腺静脉同步采血,并计算选择性指数(selectivity index,SI)、优势分泌指数(lateralization index,LI)及相对醛固酮分泌指数(relative aldosterone secretion index,RASI)。结果ACTH刺激后左右侧肾上腺静脉及外周静脉皮质醇浓度均明显升高(P<0.001),左侧肾上腺静脉SI由18.00(2.29,20.29)升高至34.76(12.10,46.86),右侧肾上腺静脉SI由26.61(5.24,31.85)升高至28.4(27.65,56.05;均P<0.001)。双侧肾上腺静脉采血成功率由基础时80%(43/54)升至ACTH刺激后93%(50/54)。LI在ACTH刺激后由2.85(1.78,6.20)降低至2.45(1.40,6.10),但差异无统计学意义(P=0.559)。其中11例患者优势分泌判定结果在基础时提示单侧优势,而在ACTH刺激后无优势分泌,其刺激后优势分泌侧RASI由0.50(0.38,1.25)降至0.37(0.22,0.84,P=0.019)。结论ACTH刺激明显升高SI并提高AVS中采血成功的检出率,但ACTH刺激会降低部分醛固酮瘤患者优势侧相对醛固酮分泌,由此降低单侧性优势分泌判定比例。Objective To explore the value of adrenocorticotrophic hormone(ACTH)stimulation in adrenal vein sampling(AVS)with its effect on the sampling success rate and lateralization determination.Methods The clinical data of 54 patients with primary aldosteronism(PA)who underwent AVS in Nanjing Drum Tower Hospital from July 2018 to June 2020 were collected retrospectively.Blood samples from bilateral adrenal veins were collected simultaneously at baseline and after ACTH stimulation.The selectivity index(SI),lateralization index(LI),and relative aldosterone secretion index(RASI)were examined.Results The concentration of serum cortisol level in left and right adrenal vein and peripheral vein increased significantly after ACTH stimulation(P<0.001).SI of left adrenal vein increased from 18.00(2.29,20.29)to 34.76(12.10,46.86),and the SI of right adrenal vein increased from 26.61(5.24,31.85)to 28.40(27.65,56.05,P<0.001).The bilateral vein sampling success rate increased from 80%(43/54)to 93%(50/54).LI decreased from 2.85(1.78,6.20)at baseline to 2.45(1.40,6.10)after ACTH stimulation without significant difference(P>0.05).Eleven patients who identified unilateral secretion at baseline demonstrated bilateral after ACTH stimulation,and the RASI of these patients decreased from 0.50(0.38,1.25)to 0.37(0.22,0.84,P=0.019).Conclusion ACTH stimulation significantly increased SI and the AVS success rate in patients with PA:ACTH stimulation decreased the relative aldosterone secretion in the dominant side of some patients with aldosterone producing adenoma,thus reduced the proportion of identified unilateral PA.

关 键 词：原发性醛固酮增多症 肾上腺静脉采血 促肾上腺皮质激素 选择性指数 优势分泌指数 

分 类 号：R586.24[医药卫生—内分泌]