Diagnostic consistency of adrenal venous sampling and CT in the different age patients of primary aldosteronism
-
摘要: 目的 探讨肾上腺静脉采血(adrenal venous sampling，AVS)和计算机断层扫描(CT)在原发性醛固酮增多症(原醛)患者中分型诊断的一致性。方法 分析2018年1月—2022年6月郑州大学第一附属医院收治的120例原醛患者的临床资料，其中男61例，女59例；中位年龄49.5岁。依据年龄将患者分为年轻组35例(年龄 < 40岁)，中老年组85例(年龄≥40岁)。使用独立样本t检验、χ2检验及Kappa值分析组间差异，分析CT和AVS在原醛患者术前评估中的诊断价值，探讨不同方法在不同年龄原醛患者中术前诊断的一致性。结果 CT和AVS对原醛分型诊断一致性中等，Kappa值为0.600，P < 0.05；年轻组(< 40岁)原醛患者CT分型诊断同AVS一致率为77.1%(27/35)，中老年组(≥40岁)CT分型诊断同AVS一致率为72.9%(62/85)，2组比较差异无统计学意义(χ2=0.228，P=0.633)。结论 AVS和CT在原醛患者术前分型诊断中的一致性中等，年轻组和中老年组CT分型诊断同AVS一致率方面无明显差异。Abstract: Objective To explore the clinical value of adrenal venous sampling(AVS) and computed tomography(CT) in clinical diagnostic value of primary aldosteronism(PA) patients.Methods The clinical data of 120 consecutive patients with PA admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2022 were analyzed. The patients' median age was 49.5 years old. And there were 61 males and 59 females. According to age, 35 cases were divided into young group(age < 40 years) and 85 cases were divided into middle-aged and elderly group(age≥40 years). Independent sample t test, χ2 test and Kappa value were used to analyze the differences between the groups. And clinical value of AVS and CT in the preoperative evaluation of PA was analyzed.Results CT and AVS had a moderate consistency in the classification diagnosis of PA(Kappa value was 0.600, P < 0.05). In the young group, the coincidence rate of CT classification diagnosis with AVS was 77.1%(27/35). And the coincidence rate of CT classification with AVS was 72.9%(62/85) in the middle-aged and elderly group. There was no significant difference between the two groups(χ2=0.228, P=0.633).Conclusion The consistency of AVS and CT in preoperative classification diagnosis in different age patients with PA was moderate, and there was no significant difference in the coincidence rate of AVS and CT classification between young patients and middle-aged and elderly patients.
-
Key words:
- adrenal venous sampling /
- computed tomography /
- primary aldosteronism /
- diagnosis /
- consistency
-
-
表 1 不同年龄段2组患者临床一般资料比较
例，X±S，M(P25，P75) 临床资料 总体(120例) 年轻组(35例) 中老年组(85例) χ2/F/Z P值 性别 0.236 0.627 男 61 19 42 女 59 16 43 分型 3.923 0.048 单侧 69 25 44 双侧 51 10 41 年龄/岁 49.5(38.0，55.8) 33.5(30.0，37.0) 53.0(49.0，58.0) -8.594 < 0.001 BMI/(kg/m2) 25.8±3.4 25.5±4.1 25.9±3.1 3.202 0.076 醛固酮/(pg/mL) 344.0(242.1，568.5) 349.7(254.3，588.4) 341.6(234.0，561.9) -0.430 0.667 动态收缩压/mmHga) 133.5(127.3，141.0) 134.5(129.5，142.5) 133.0(126.0，140.5) -0.708 0.479 动态舒张压/mmHg 84.0(79.0，90.0) 86.0(80.0，93.0) 82.0(77.0，82.5) -2.523 0.052 血钾值/(mmol/L) 3.1(2.6，3.5) 3.0(2.8，3.3) 3.1(2.6，3.5) -0.572 0.568 ARR 199.5(86.7，342.2) 220.0(80.0，361.4) 107.4(54.3，174.6) -0.531 0.595 高血压病程/月 60(12，120) 5(24，51) 96(36，138) -4.237 < 0.001 注：a)1 mmHg=0.133 kPa；动态收缩压、舒张压为24 h动态血压的白天血压平均值结果。 
下载: 导出CSV
表 2 CT和AVS在原醛分型诊断中的一致性比较
例 CT分型 AVS分型 左侧优势 右侧优势 双侧 总计 左侧优势 32 2 8 42 右侧优势 1 20 5 26 双侧 10 5 37 52 合计 43 27 50 120
下载: 导出CSV
表 3 年轻组和中老年组患者CT对原醛分型诊断同AVS一致率比较
例 组别 AVS分型诊断 符合 不符合 总计 年轻组(< 40岁) 27 8 35 中老年组(≥40岁) 62 23 85 合计 89 31 120
下载: 导出CSV
-
[1] Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2016, 101(5): 1889-1916. doi: 10.1210/jc.2015-4061
[2] 李慧, 卞晓洁, 叶定伟. 腹腔镜切除肾上腺醛固酮腺瘤的短期及长期随访研究[J]. 临床泌尿外科杂志, 2022, 37(3): 205-209. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2022.03.010
[3] 中华医学会内分泌学分会. 原发性醛固酮增多症诊断治疗的专家共识(2020版)[J]. 中华内分泌代谢杂志, 2020, 36(9): 727-736. doi: 10.3760/cma.j.cn311282-20200615-00444
[4] Küpers EM, Amar L, Raynaud A, et al. A clinical prediction score to diagnose unilateral primary aldosteronism[J]. J Clin Endocrinol Metab, 2012, 97(10): 3530-3537. doi: 10.1210/jc.2012-1917
[5] 中国高血压防治指南修订委员会, 高血压联盟(中国, 中华医学会心血管病学分会中国医师协会高血压专业委员会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1): 24-56. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ201904005.htm
[6] 虢晶翠, 陈小宇, 张俊清, 等. 原发性醛固酮增多症合并肾上腺性库欣综合征的临床特点[J]. 中华医学杂志, 2020, 100(36): 2828-2833. doi: 10.3760/cma.j.cn112137-20200519-01585
[7] McLachlan MS, Roberts EE. Demonstration of the normal adrenal gland by venography and gas insufflation[J]. Br J Radiol, 1971, 44(525): 664-671. doi: 10.1259/0007-1285-44-525-664
[8] 李艳珍, 董徽, 陈阳, 等. 比较肾上腺CT和分侧肾上腺静脉取血对原发性醛固酮增多症分侧诊断的符合率[J]. 中国循环杂志, 2019, 34(7): 698-702. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201907014.htm
[9] 陈宸, 何云锋, 张尧, 等. 多层螺旋CT与肾上腺静脉取血对原发性醛固酮增多症患者定位诊断价值的比较[J]. 中华泌尿外科杂志, 2019, 40(5): 385-388. doi: 10.3760/cma.j.issn.1000-6702.2019.05.014
[10] Williams TA, Lenders JWM, Mulatero P, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort[J]. Lancet Diabetes Endocrinol, 2017, 5(9): 689-699. doi: 10.1016/S2213-8587(17)30135-3
[11] Ishidoya S, Kaiho Y, Ito A, et al. Single-center outcome of laparoscopic unilateral adrenalectomy for patients with primary aldosteronism: lateralizing disease using results of adrenal venous sampling[J]. Urology, 2011, 78(1): 68-73. doi: 10.1016/j.urology.2010.12.042
[12] Zhu LM, Zhang Y, Zhang H, et al. Comparison between adrenal venous sampling and computed tomography in the diagnosis of primary aldosteronism and in the guidance of adrenalectomy[J]. Medicine, 2016, 95(39): e4986. doi: 10.1097/MD.0000000000004986
[13] Aono D, Kometani M, Karashima S, et al. Primary aldosteronism subtype discordance between computed tomography and adrenal venous sampling[J]. Hypertens Res, 2019, 42(12): 1942-1950. doi: 10.1038/s41440-019-0310-y
[14] 何德化, 林开敏, 张紫冠, 等. 分侧肾上腺静脉取血术对高血压合并肾上腺病变的临床价值[J]. 中华高血压杂志, 2020, 28(10): 971-977. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGZ202010020.htm
[15] 林跃丽, 罗建光, 刘穗玲, 等. 肾上腺静脉采血学习曲线的分析[J]. 中南大学学报(医学版), 2021, 46(9): 996-1002. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYD202109012.htm
[16] 高宛生, 黄文波, 杨彦峰, 等. 肾上腺静脉采血在原发性醛固酮增多症患者术前评估中的临床价值[J]. 中华实验外科杂志, 2021, 38(12): 2381-2384.
-