原发性醛固酮增多症组织病理学分型特征及其对转归的影响  

Characteristics of histopathology of primary aldosteronism and its impact on prognosis

作　　者：马国栋 杨宇宏 鲍美玲[2] 周春高[3] 秦超[4] 陶俊[4] 王敏[5] 严雨桐 刘雨晴 计铭钰 周梅 孙敏[1] Ma Guodong;Yang Yuhong;Bao Meiling;Zhou Chungao;Qin Chao;Tao Jun;Wang Min;Yan Yutong;Liu Yuqing;Ji Mingyu;Zhou Mei;Sun Min(Department of Endocrinology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Pathology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Interventional Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Urology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Endocrinology,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210031,China)

机构地区：[1]南京医科大学第一附属医院内分泌科,南京210029 [2]南京医科大学第一附属医院病理科,南京210029 [3]南京医科大学第一附属医院介入放射科,南京210029 [4]南京医科大学第一附属医院泌尿外科,南京210029 [5]南京医科大学第四附属医院内分泌科,南京210031

出　　处：《中华内分泌代谢杂志》2024年第12期1052-1058,共7页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(82300887);江苏省卫生健康委员会医学科研重点项目(K2023046)。

摘　　要：目的分析单侧原发性醛固酮增多症(primary aldosteronism,PA)患者术后原发性醛固酮增多症的组织病理学(histopathology of primary aldosteronism,HISTALDO)共识分型特征,探讨其与临床特征及术后转归的相关性。方法回顾性纳入2017年4月至2022年4月南京医科大学第一附属医院收治的105例单侧肾上腺切除的PA患者,对其术后病理依据最新HISTALDO共识分型。比较HISTALDO分型和传统分型差异,分析不同分型临床特征及原发性醛固酮增多症手术预后(primary aldosteronism surgical outcome,PASO)的差异。结果HISTALDO分型中67.6%为经典型,32.4%为非经典型。经典型组年龄、体重指数、最低血钾、空腹血糖、HbA 1C及免疫组化中阴性结节占比均低于非经典型组(均P<0.05);收缩压、舒张压、低钾血症患病率及24 h尿钾均高于非经典型组(均P<0.05)。依据PASO标准,总人群临床和生化完全缓解率分别为41.7%和83.3%。HISTALDO经典型组的临床和生化完全缓解率均明显高于非经典型组(均P<0.05)。多因素logistic回归分析显示,血钾水平(OR=0.15,95%CI 0.03~0.84,P<0.05)和免疫组化中阴性结节占比(OR=0.20,95%CI 0.05~0.86,P<0.05)更低的患者,术后病理为经典型的概率更高,而经典型病理类型与临床和生化治愈独立相关(均P<0.05)。结论标准化的HISTALDO病理分型能够提高单侧PA病理诊断准确性,更好预测其疾病转归,为PA患者精准分层管理提供基础。ObjectiveTo analyze the histopathological features of primary aldosteronism(PA)based on the histopathology of primary aldosteronism(HISTALDO)consensus classification in patients undergoing unilateral adrenalectomy and explore its correlation with clinical characteristics and postoperative outcomes.MethodsA retrospective study was conducted on 105 unilateral PA patients treated at the First Affiliated Hospital of Nanjing Medical University between April 2017 and April 2022.Postoperative histopathology was classified according to the latest HISTALDO consensus and compared with traditional classifications.Differences in clinical features and primary aldosteronism surgical outcomes(PASO)were analyzed across classifications.ResultsHISTALDO classification showed that 67.6%of patients were classical subtype and 32.4%were non-classical subtype.Compared to the non-classical group,the classical group showed lower age,body mass index,serum potassium concentration,fasting blood glucose,HbA 1C,and proportion of CYP11B2 negative nodules as well as higher systolic blood pressure,diastolic blood pressure,prevalence of hypokalemia,and 24-hour urine potassium(all P<0.05).Based on PASO criteria,complete clinical and biochemical success were achieved in 41.7%and 83.3%subjects respectively.A significantly higher proportion of classical group displayed complete clinical and biochemical success than nonclassical group(all P<0.05).Multivariate logistic regression analysis showed that lower serum potassium concentration(OR=0.15,95%CI 0.03-0.84,P<0.05)and proportion of CYP11B2 negative nodules(OR=0.20,95%CI 0.05-0.86,P<0.05)were related to classical pathological type,and classical pathological type was independently related to clinical and biochemical remission(all P<0.05).ConclusionStandardized HISTALDO histopathological classification enhances diagnostic accuracy and predicts postoperative outcomes in unilateral PA,providing a foundation for precise stratified management of PA patients.

关 键 词：原发性醛固酮增多症 CYP11B2免疫组化 病理诊断 HISTALDO共识 PASO标准 

分 类 号：R73[医药卫生—肿瘤]