Effect and prognosis analysis of surgical treatment on adrenal incidentalomas patients with hypertension and normally endocrinological assessment
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摘要: 目的:探讨高血压伴无肾上腺激素生化异常的肾上腺偶发瘤患者行肾上腺占位切除术后高血压的改善效果及影响术后血压改善的相关因素。方法:回顾性分析2014年1月—2017年12月在我院接受肾上腺占位切除术的88例患者的临床、病理资料及随访情况。男50例,女38例,年龄27~76岁,平均(53.61±10.92)岁;肿瘤最大直径中位数为2.4 cm;左侧41例,右侧47例。88例患者均具有高血压病史,术前血浆醛固酮、血浆醛固酮/肾素比值、血浆游离皮质醇、尿儿茶酚胺、血浆甲氧基肾上腺素、血浆甲氧基去甲肾上腺素、电解质等均正常。随访患者术后1年的血压改善情况以及控制血压的服药量。将术后血压恢复正常或控制血压的服药量减少的患者作为观察组,将术后血压与用药无明显变化的患者作为对照组,根据logistic回归分析探讨影响术后血压改善的相关因素。结果:88例患者中,术后血压恢复正常或控制血压的服药量减少的患者有70例,术后血压与用药无明显变化的患者有18例,高血压的改善率为79.5%。观察组70例患者术后病理类型分别为:肾上腺皮质腺瘤48例(68.57%),嗜铬细胞瘤12例(17.14%),髓脂肪瘤5例(7.14%),肾上腺结节性增生3例(4.29%),节细胞神经瘤2例(2.86%);对照组18例患者术后病理类型分别为:肾上腺皮质腺瘤17例(94.44%),嗜铬细胞瘤1例(5.56%)。两组患者临床资料分析显示,观察组与对照组相比,年龄、术前血压、血浆醛固酮、血浆醛固酮/肾素比值、血浆游离皮质醇、血浆甲氧基肾上腺素、血浆甲氧基去甲肾上腺素、肿瘤最大直径、肿瘤偏侧、ASA分级差异无统计学意义(P＞0.05),而两组患者的性别比例和BMI比较差异有统计学意义(P＜0.05)。logistic回归分析显示BMI(OR=1.312,95%CI:1.064~1.617,P=0.011)是影响术后血压改善的独立因素。BMI较低者,术后血压改善情况更好。结论:本研究认为,对于高血压伴无肾上腺激素生化异常的肾上腺偶发瘤患者,手术治疗可使一部分患者显著获益,尤其是对于BMI较低(BMI≤25 kg/m2)的患者,手术治疗指征可适当放宽。Abstract: Objective: To investigate the effect of adrenal surgery on blood pressure in adrenal incidentalomas patients with normally endocrinological assessment and to assess factors affecting hypertension outcomes after surgery.Methods: Data of 88 patients who underwent partial adrenalectomy between Jan. 2014 and Dec. 2017 were studied. There were 50 males and 38 females, whose age ranged from 27 to 76 years old, with an average age of(53.61 ±10.92) years. The median diameter of the tumor was 2.4 cm, 41 cases on the left side and 47 cases on the right side. All the 88 patients had a history of hypertension. In preoperative assessment, plasma aldosterone, plasma aldosterone to renin ratio, plasma free cortisol, urinary catecholamine,plasma metanephrine,plasma normetanephrine, electrolytes were normal. The postoperative blood pressure and the dose of anti-hypertension drugs were followed up for one year. The patients whose postoperative blood pressure returned to normal or dose of anti-hypertension drugs were reduced were regarded as the observation group, while the patients with no improvement in blood pressure as the control group. Factors affecting hypertension outcomes after surgery were determined using logistic regression.Results: A total of 88 patients, 70 patients had returned to normal blood pressure or reduced the dose of anti-hypertension drugs, while 18 patients had no significant change in blood pressure after operation, and the improvement rate was 79.5%. The postoperative pathological types of 70 patients in the observation group were adrenocortical adenoma 48 cases(68.57%), pheochromocytoma 12 cases(17.14%), myelolipoma 5 cases(7.14%), adrenal nodular hyperplasia 3 cases(4.29%), ganglioneuroma 2 cases(2.86%). The postoperative pathological types of 18 patients in the control group were 17 cases of adrenocortical adenoma(94.44%) and 1 case of pheochromocytoma(5.56%). The analyses of clinical data of the two groups showed that there was no significant difference in age, preoperative blood pressure, plasma aldosterone, plasma aldosterone to renin ratio, plasma free cortisol, plasma metanephrine, plasma normetanephrine, maximum diameter of tumor, tumor laterality or ASA grade(P＞0.05), but there was significant difference in sex ratio and BMI between the two groups(P＜0.05). Logistic regression analyses showed that BMI(OR=1.312, 95%CI: 1.064-1.617, P=0.011) was the only independent factor associated with favorable postoperative hypertension.Conclusion: Surgical treatment can improve concomitant hypertension in most patients with adrenal incidentaloma without biochemical abnormalities, especially for patients with low BMI(BMI≤25 kg/m2).
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Key words:
- hypertension /
- adrenal incidentaloma /
- surgical treatment
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