^(68)Ga-pentixafor PET/CT在原发性醛固酮增多症外科诊断和预后评估中的应用  

Clinical application of ^(68)Ga-pentixafor PET/CT in surgical diagnosis and prognosis evaluation of primary aldosteronism and correlation analysis of clinical prognosis

作　　者：郑国洋[1] 丁洁 霍力[2] 童安莉[3] 张玉石[1] 李汉忠[1] 纪志刚[1] 王文达[1] 赵欣[1] Zheng Guoyang;Ding Jie;Huo Li;Tong Anli;Zhang Yushi;Li Hanzhong;Ji Zhigang;Wang Wenda;Zhao Xin(Department of Urology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Nuclear Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Endocrinology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院泌尿外科,北京100730 [2]中国医学科学院,北京协和医学院,北京协和医院核医学科,北京100730 [3]中国医学科学院,北京协和医学院,北京协和医院内分泌科,北京100730

出　　处：《中华泌尿外科杂志》2022年第11期812-817,共6页Chinese Journal of Urology

基　　金：中央高水平医院临床科研业务费(2022-PUMCH-B-010,2022-PUMCH-C-028)。

摘　　要：目的探讨以CXCR4为特异性靶点的^(68)Ga-pentixafor PET/CT在原发性醛固酮增多症(原醛症)外科诊断和预后评估中的应用价值。方法回顾性分析北京协和医院2018年6月至2022年3月收治的72例原醛症患者的临床资料。男37例,女35例;年龄(48.3±9.5)岁;单发病灶59例,多发病灶13例;病灶最大径(1.60±0.54)cm;术前收缩压为(177.3±23.9)mmHg(1mmHg=0.133kPa),舒张压为(107.6±13.2)mmHg;术前血钾水平(2.62±0.56)mmol/L,醛固酮浓度(17.98±4.66)ng/dl,血浆肾素活性0.01(0.01,0.09)ng/(ml·h)。所有患者均采用卡托普利抑制试验确诊为原醛症。所有患者均行^(68)Ga-pentixafor PET/CT检查,根据结果制订手术策略:单发病灶、单侧多发阳性病灶、一侧病灶阳性而对侧阴性者,手术切除阳性侧病灶或全部腺体;双侧阳性病灶者,手术切除阳性程度更显著的一侧病灶或全部腺体;多发病灶均为阴性者,结合CT检查或双侧肾上腺静脉采血结果决定手术策略。术后6~12个月随访血压、血钾、内分泌检查指标。分析^(68)Ga-pentixafor PET/CT检查结果与患者临床特征、预后的关系。结果72例中^(68)Ga-pentixafor PET/CT阳性62例(86.1%),病灶的最大标准摄取值(SUVmax)中位值为11.1(7.1,16.2)。SUVmax与病灶最大径呈正相关(r=0.468,P<0.001),与血钾水平呈负相关(r=-0.437,P<0.001);而与术前收缩压、舒张压、血浆肾素活性和醛固酮浓度无显著相关性(均P>0.05)。术后病理确诊腺瘤63例,结节状增生9例;^(68)Ga-pentixafor PET/CT在腺瘤中的阳性率高于结节状增生[90.5%(57/63)与55.6%(5/9),P=0.018],腺瘤的SUVmax高于结节状增生[11.9(7.8,16.2)与4.3(3.4,11.3),P=0.022]。术后治愈32例,好转37例,未愈3例;治愈患者的SUVmax明显高于好转患者[15.4(8.1,22.7)与10.1(6.8,13.3),P=0.013]。59例单发病灶患者中50例^(68)Ga-pentixafor PET/CT结果阳性,切除阳性病灶后治愈23例,好转27例,治疗获益率为100.0%(50/50)。13例多发病灶患者中12例(9Objective To explore the clinical value of ^(68)Ga-pentixafor PET/CT targeting for CXCR4 in the diagnosis and prognosis evaluation of primary aldosteronism(PA).Methods Retrospective analysis was performed on information of 72 patients diagnosed with PA who received operations according to the results of ^(68)Ga-pentixafor PET/CT in our hospital.There were 37 males and 35 females,with the average age of(48.3±9.5)years old.The average lesion diameter was(1.60±0.54)cm.The preoperative systolic and diastolic blood pressure were(177.3±23.9)mmHg and(107.6±13.2)mmHg,respectively.The average preoperative potassium level was(2.62±0.56)mmol/L.The average aldosterone concentration was(17.98±4.66)ng/dl,and the median plasma renin activity was 0.01(0.01,0.09)ng/(ml·h).All patients underwent ^(68)Ga-pentixafor PET/CT examination,which lead to the decision of surgical strategies.For those patients with single lesion,multiple lesions in one side or positive lesion in one side but negative in the opposite side,surgical resection of the positive side lesion or total adrenalectomy was considered.For those patients with bilateral positive lesions,surgical resection of the side with more significant positive lesions or total adrenalectomy was considered.For those with negative multiple lesions,the surgical strategy was designed according to the results of CT examination or AVS.The positive rate of ^(68)Ga-pentixafor PET/CT and its relationship with the clinical characteristics and prognosis of patients were analyzed.Results The results of ^(68)Ga-pentixafor PET/CT were positive in 62 of 72 patients diagnosed with PA(86.1%),and the median SUVmax value was 11.1(7.1,16.2).The SUVmax value was positively correlated with the maximum diameter of adrenal lesion(r=0.468)and negatively correlated with blood potassium levels(r=-0.437),while not significantly correlated with other clinical characteristics.The positive rate of adenoma by ^(68)Ga-pentixafor PET/CT was higher than that of nodular hyperplasia[90.5%(57/63)vs.55.6%(5/9),P=0.01

关 键 词：醛固酮增多症 肾上腺 预后 正电子发射计算机断层显像 镓放射性同位素 

分 类 号：R699.3[医药卫生—泌尿科学]