| 张卫东,张佳伟,宋志强,马 哲,刘建国.分侧肾上腺静脉取血与肾上腺CT对原发性醛固酮增多症诊断的价值比较研究[J].,2022,(10):1841-1845 |
| 分侧肾上腺静脉取血与肾上腺CT对原发性醛固酮增多症诊断的价值比较研究 |
| Comparative Study on the Value of Lateral Adrenal Vein Blood Sampling and Adrenal CT in the Diagnosis of Primary Aldosteronism |
| 投稿时间：2022-01-12 修订日期：2022-01-31 |
| DOI：10.13241/j.cnki.pmb.2022.10.009 |
| 中文关键词: 分侧肾上腺静脉取血 肾上腺CT 原发性醛固酮增多症 诊断价值 |
| 英文关键词: Lateral adrenal vein blood sampling Adrenal CT Primary aldosteronism Diagnostic value |
| 基金项目:北京首都特色临床研究项目（Z161100000516167） |
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| 中文摘要: |
| 摘要 目的：研究原发性醛固酮增多症（PA）患者行分侧肾上腺静脉取血（AVS）、肾上腺CT诊断的效果。方法：数据遴选本院2018年1月-2021年11月收治的70例原发性醛固酮增多症患者，所有患者均行肾上腺CT、AVS诊断，对最终诊断结果比较分析。结果：收缩压、舒张压、空腹血糖、总胆固醇在单双侧间无差异（P＞0.05），双侧肾素活性、血清醛固酮肾素比值较单侧存在差异（P＜0.05）；肾上腺CT与AVS诊断的符合率情况：肾上腺CT显示为单侧异常、双侧异常及双侧正常患者，AVS符合率分别为65.00 %、31.25 %、50.00 %；单独肾上腺CT诊断：灵敏度为57.1 %，特异度为25.7 %，肾上腺静脉采血诊断：灵敏度为74.3 %，特异度为42.9 %；并联联合诊断灵敏度为100.0 %，特异度为26.3 %，串联诊断灵敏度为19.5 %，特异度为100.0 %。结论：PA是临床常见疾病，具有患病率高、预后差等特点，临床依靠临床表现、血液生化检查诊断PA疾病，但仅借助血液生化检验进行诊断治疗较困难，功能定位是治疗关键。实际工作中，可以临床通过CT检查及AVS检查功能定位诊断，但对于PA患者来说，仅借助肾上腺CT诊断结果制定治疗方案，可能导致手术侧选择错误，建议愿意接受肾上腺手术治疗者，推荐先行AVS，正确选择治疗方案，达到改善预后作用，效果较理想、值得临床借鉴推广。 |
| 英文摘要: |
| ABSTRACT Objective: To study the effect of partial adrenal vein blood sampling (AVS) in patients with primary aldosteronism (PA) The effect of CT diagnosis of adrenal gland. Methods: 70 patients with primary aldosteronism treated in our hospital from January 2018 to November 2021 were selected. All patients were diagnosed by adrenal CT and AVS. The final diagnostic results were compared and analyzed. Results: There was no significant difference in systolic blood pressure, diastolic blood pressure, fasting blood glucose and total cholesterol between one and two sides (P>0.05); There were differences in renin activity and serum renin aldosterone renin ratio between the two sides (P<0.05). The coincidence rate of AVS was 65.00 %, 31.25 % and 50.00 % respectively; Single adrenal CT diagnosis: sensitivity was 57.1 %, specificity was 25.7 %, adrenal venous blood collection diagnosis: sensitivity was 74.3 %, specificity was 42.9%; The sensitivity and specificity of parallel combined diagnosis were 100.0 %, 26.3%, 19.5 % and 100.0 %, respectively. Conclusion: PA is the clinical common disease, with high prevalence, poor prognostic features, clinical rely on clinical manifestation, blood biochemical examination in the diagnosis of PA disease, but only with the help of blood biochemical test for pathologic classification is more difficult, function orientation is the key treatment, through by surgery treatment of adrenal tumor or unilateral primary adrenal hyperplasia can heal, But bilateral adrenal hyperplasia drug treatment can be used to promote recovery, practice, clinical by CT examination and AVS check clear etiology classification is feasible, but for patients with PA, only with the aid of planned treatment in adrenal CT diagnosis, possible unnecessary adrenal surgery, should choose to give non-surgical treatment, cause upper respiratory side choose wrong. It is recommended that patients who are willing to perform adrenal surgery should have AVS first and choose the right treatment plan to improve the prognosis. The effect is ideal and worthy of praise. |
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