肾上腺静脉取样的对侧抑制指数在原发性醛固酮增多症亚型鉴定中的作用:一项回顾性分析  

Role of Contralateral Suppression Index of Adrenal Venous Sampling in Primary Aldosteronism Subtyping:A Retrospective Analysis

作　　者：韦超萍 潘亚锦 黄靖 俞杰 韦利霞 李森 伍思颖 陈美兰 朱双贝 陈珊珊 李健玲[1] WEI Chaoping;PAN Yajin;HUANG Jing;YU Jie;WEI Lixia;LI Sen;WU Siying;CHEN Meilan;ZHU Shuangbei;CHEN Shanshan;LI Jianling(Department of Cardiology,The First Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530021,China)

机构地区：[1]广西医科大学第一附属医院高血压病区,广西南宁530021

出　　处：《中国医药指南》2025年第1期1-5,共5页Guide of China Medicine

基　　金：国家自然科学基金(No.81960087);国家自然科学基金(No.82360093);广西医疗卫生适宜技术开发与推广应用项目(No.S2018078);2023年广西重点研发计划项目(2023AB01384)。

摘　　要：目的本研究旨在确定原发性醛固酮增多症(PA)亚型的内在特征,以便在双侧肾上腺静脉采样(AVS)无法确定的情况下,完善PA的亚型诊断。方法本文对广西医科大学第一附属医院2016年10月至2021年12月的PA患者进行了回顾性研究。以双侧AVS为诊断标准,将受试者分为两类:醛固酮腺瘤(APA)患者和特发性醛固酮增多症(IHA)患者。本研究通过对基线数据、肾上腺CT成像和AVS检查结果的整理,对各组患者的基线特征进行比较,并评估肾上腺CT、对侧抑制指数(CSI)的诊断一致性,以及它们在PA分型中的综合应用。结果APA组患者的血钾、甘油三酯水平低于IHA组(P<0.05)。肾上腺CT与AVS的一致性在确定单侧腺瘤时达到60.17%,而单侧增生的一致性为30.69%。在单侧优势分泌的病例中存在对侧抑制(CSI<1)的比例为82.32%。左侧和右侧CSI<1与AVS结果的符合率为36.72%和46.96%。将肾上腺CT结果与CSI<1整合后,在亚型诊断方面与AVS的一致率达到70.59%。此外,将明显的醛固酮分泌和自发性低钾血症作为诊断标准可进一步提高准确性。结论当单侧AVS无法诊断PA时,通过肾上腺CT检测单侧腺瘤与对侧CSI<1的协同作用可在一定程度上提高PA亚型诊断的吻合率。Objective The aim of this study was to determine the intrinsic characteristics of primary aldosteronism(PA)subtypes in order to refine the diagnosis of PA subtypes when bilateral adrenal vein sampling(AVS)is not possible.Methods We conducted a retrospective study on PA patients at the First Affiliated Hospital of Guangxi Medical University from October 2016 to December 2021.With bilateral AVS as the diagnostic benchmark,subjects were classified into two categories:those with aldosterone-producing adenoma(APA)and those with idiopathic hyperaldosteronism(IHA).This research involved the compilation of baseline data,adrenal CT imaging,and AVS findings,enabling the comparison of baseline features across the groups,as well as evaluating the diagnostic consistency of adrenal CT,the contralateral suppression index(CSI),and their collective application for PA subtyping.Results Patients in the APA group had lower potassium and triglyceride levels than those in the IHA group(P<0.05).The concordance between adrenal CT and AVS reached 60.17%in identifying unilateral adenomas,whereas the concordance for unilateral hyperplasia was 30.69%.The presence of contralateral suppression(CSI<1)in cases of unilateral dominant secretion was 82.32%.The concordance between left and right CSI<1 and AVS findings was 36.72%and 46.96%.Integration of adrenal CT findings with CSI<1 resulted in 70.59%agreement with AVS in terms of subtype diagnosison.The inclusion of pronounced aldosterone secretion and spontaneous hypokalemia as diagnostic criteria could further elevate accuracy.Conclusions The synergy of unilateral adenoma detection via adrenal CT with a contralateral CSI<1 substantially improves the concordance rate for diagnosing PA subtypes when unilateral AVS is non-diagnostic.

关 键 词：原发性醛固酮增多症 醛固酮腺瘤 特发性高醛固酮增多症 肾上腺静脉取样 肾上腺CT 对侧抑制指数 

分 类 号：R586.24[医药卫生—内分泌]