肾上腺CT血钾和血醛固酮对原发性醛固酮增多症分型的诊断价值研究  

Diagnostic value of adrenal CT combined with serum potassium and serum aldosterone in the classification diagnosis of primary aldosteronism

作　　者：马笑堃[1] 秦贵军[1] 吉鸿飞[1] 王海滨[1] 赵霖 MA Xiao-kun;QIN Gui-jun;JI Hong-fei;WANG Hai-bin;ZHAO Lin(Department of Endocrinology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院内分泌科,河南郑州450052

出　　处：《中国实用内科杂志》2024年第11期928-932,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81974110)。

摘　　要：目的研究肾上腺CT、血钾、血醛固酮对原发性醛固酮增多症(PA)分型诊断的价值。方法选取郑州大学第一附属医院2020年8月至2022年3月收治的完成肾上腺静脉采血检查(AVS)的PA患者共计113例。将CT显示为单侧病变患者(n=74)分为CT与AVS结果不一致组(n=33)、CT与AVS一致组(n=41)。研究两组血浆醛固酮浓度(PAC)等指标的差异。logistic回归分析探讨CT与AVS一致性的预测因素。应用ROC曲线评估血钾、盐水后PAC对CT与AVS一致性的预测价值。结果CT与AVS结果一致组相较不一致组,前者年龄更小、血钾更低,随机位PAC、随机位PAC与肾素比值(ARR)以及盐水后PAC水平更高。logistic回归分析显示血钾(OR 0.111,95%CI 0.018~0.692,P=0.018)和盐水后PAC(OR 1.008,95%CI 1.001~1.015,P=0.021)是预测CT与AVS一致性的独立预测因子。ROC曲线分析显示血钾的最佳切点为3.1 mmo/L(AUROC 0.835,灵敏度0.788,特异度0.805,P=0.000),盐水后PAC最佳切点为20.00 ng/dL(AUROC 0.882,灵敏度0.882,特异度0.844,P=0.000),年龄的最佳切点为46岁(AUROC 0.638,灵敏度0.758,特异度0.561,P=0.043)。结论CT显示单侧病变的患者,若血钾小于3.1 mmol/L,盐水后PAC大于20ng/dL,提示单侧PA的可能性大。Objective To study the role of adrenal CT,serum potassium and aldosterone in the classified diagnosis of PA. Methods A total of 113 patients with PA were enrolled,who completed AVS examination in the First Affiliated Hospital of Zhengzhou University from August 2020 to March 2022. Patients with unilateral lesions on CT(n=74)were divided into the inconsistent CT and AVS group(n =33)and the consistent CT and AVS group(n = 41). The differences in serum potassium and PAC between the two groups were studied.The logistic regression analysis was used to investigate the predictors of consistency between CT and AVS. ROC curve was used to evaluate the predictive value of serum potassium and post-SIT PAC for the consistency of CT and AVS. Results Compared with the inconsistent AVS group,the consistent AVS group had younger age,lower serum potassium,higher PAC(whatever at random site or post-SIT)and higher ARR.The logistic regression analysis showed that serum potassium(OR 0.111,95% CI 0.018-0.692,P=0.018)and post-SIT PAC(OR 1.008,95% CI 1.001-1.015,P=0.021)were independent predictors of consistency between CT and AVS. ROC curve analysis showed that the optimal cut-off point of serum potassium was 3.1 mmol/L(AUROC 0.835,sensitivity 0.788,specificity 0.805,P=0.000). The optimal cut-off point of post-SIT PAC was 20.00 ng/dL(AUROC 0.882,sensitivity0.882,specificity 0.844,P=0.000). The optimal cut-off point of age was 46 years old(AUROC 0.638,sensitivity 0.758,specificity 0.561,P=0.043). Conclusion In patients with unilateral lesions shown on CT,if blood potassium is less than 3.1 mmol/L and post-SIT PAC is greater than 20ng/dL,the unilateral PA is possible.

关 键 词：原发性醛固酮增多症 肾上腺静脉采血 低血钾 醛固酮 

分 类 号：R58[医药卫生—内分泌]