原发性醛固酮增多症患者右侧肾上腺优势分泌侧预测模型的建立与验证  

Establishment and validation of a prediction model of the right adrenal dominant secretory side in patients with primary hyperaldosteronism

作　　者：廖华生 吴逸钊 邓偲 张利朝 Liao Huasheng;Wu Yizhao;Deng Cai;Zhang Lichao(Department of Urology,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510220,China)

机构地区：[1]广州医科大学附属第二医院泌尿外科,广州510220

出　　处：《中国医师杂志》2025年第3期382-387,共6页Journal of Chinese Physician

基　　金：广东省医学科学技术研究基金(B2024016)。

摘　　要：目的探讨预测原发性醛固酮增多症(PHA)患者右侧肾上腺优势分泌侧的独立危险因素,以此构建并验证优势分泌侧的预测模型,为PHA患者的分型诊断治疗提供依据。方法回顾性分析广州医科大学附属第二医院2015年1月—2023年7月收治的82例行肾上腺静脉采血(AVS)PHA患者的临床资料,按7∶3比例分为训练集(58例)和验证集(24例),利用单因素和多因素logistic回归分析筛选出预测右侧肾上腺优势分泌侧的危险因素,再联合危险因素构建优势分泌侧预测模型,并通过绘制受试者工作特征(ROC)曲线、校准曲线及临床决策曲线(DCA曲线)来验证优势分泌侧列线图预测模型的预测效能和临床适用性。结果(1)单因素及多因素logistic分析结果显示,下腔静脉醛固酮(ALD2)浓度及肾上腺CT影像学结果提示右侧肾上腺单侧结节(RJJ)是行AVS的PHA患者发生右侧肾上腺优势分泌的独立危险因素(均P<0.05)。(2)ALD2变量对应ROC曲线下面积(AUC)为0.898(95%CI:0.7357~0.9861),灵敏度和特异度分别为95.2%和81.1%;RJJ变量对应AUC为0.750(95%CI:0.6831~0.9763),灵敏度和特异度分别为90.5%和86.7%;两变量在验证集中的AUC分别为0.926、0.778。(3)校准曲线和DCA曲线均表明该预测模型具有较好的一致性和临床适用性,能够产生较好的临床效益。结论ALD2及肾上腺CT结果提示RJJ是预测右侧肾上腺优势分泌侧的独立危险因素,利用这些危险因素构建的预测模型具有较好的预测效能和临床适用性。ObjectiveTo explore the independent risk factors for predicting the right adrenal dominant secretory side in patients with primary hyperaldosteronism(PHA),so as to construct and verify the prediction model of the dominant secretory side,and provide evidence for the diagnosis and treatment of PHA patients.MethodsClinical data of 82 PHA patients undergoing adrenal vein sampling(AVS)admitted to the Second Affiliated Hospital of Guangzhou Medical University from January 2015 to July 2023 were retrospectively analyzed,and divided into the training set(58 cases)and the verification set(24 cases)according to the ratio of 7∶3.Single factor and multiple factor logistic regression analysis were used to screen out the risk factors for predicting the right adrenal dominant secretory side,and then combined with the risk factors to build the prediction model of the dominant secretory side.The predictive efficiency and clinical applicability of the predominance secretory nomogram prediction model were verified by drawing receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA curve).Results(1)Univariate and multivariate logistic analysis showed that the concentration of aldosterone(ALD2)in inferior vena cava and the results of adrenal CT imaging suggested that the right adrenal unilateral nodule(RJJ)were independent risk factors for the occurrence of right adrenal dominant secretion in PHA patients undergoing AVS(all P<0.05).(2)The area under ROC curve(AUC)corresponding to ALD2 variable was 0.898(95%CI:0.7357-0.9861),and the sensitivity and specificity were 95.2%and 81.1%,respectively.The corresponding AUC of RJJ variable was 0.750(95%CI:0.6831-0.9763),and the sensitivity and specificity were 90.5%and 86.7%,respectively.The AUC of the two variables in the verification set were 0.926 and 0.778,respectively.(3)Calibration curve and DCA curve showed that the prediction model had good consistency and clinical applicability,and can produce good clinical benefits.ConclusionsALD2 and adrenal CT

关 键 词：醛固酮增多症 肾上腺 优势分泌侧 预测模型 

分 类 号：R586[医药卫生—内分泌] R58[医药卫生—内科学]