| 体位试验联合肾上腺CT诊断原发性醛固酮增多症中醛固酮瘤的价值初探 |
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| 引用本文： | 罗盼雨,陈士涵,余叶蓉. 体位试验联合肾上腺CT诊断原发性醛固酮增多症中醛固酮瘤的价值初探[J]. 四川大学学报(医学版), 2020, 51(1): 87-91. DOI: 10.12182/20200160604 |
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| 作者姓名： | 罗盼雨 陈士涵 余叶蓉 |
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| 作者单位： | 四川大学华西医院 内分泌代谢科 （成都 611041） |
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| 摘 要： | 目的 以分侧肾上腺静脉采血术(AVS)和/或术后病理诊断为金标准，分析体位试验联合肾上腺CT扫描对醛固酮瘤（APA）的诊断价值。 方法 回顾性收集四川大学华西医院出院诊断中包含原发性醛固酮增多症（PA）患者的资料，纳入符合要求的APA与特发性醛固酮增多症（IHA）患者，收集两组患者的临床资料，分析体位试验联合肾上腺CT扫描对APA的诊断价值。 结果 共纳入APA患者83例，IHA患者42例。以体位试验中立位血醛固酮水平(PAC)较卧位上升幅度值诊断APA绘制受试者工作特征（ROC）曲线，曲线下面积为0.721，最佳诊断切点值为11%，即立位较卧位PAC上升幅度（体位试验）<11%为诊断性试验阳性（无反应），以此为判断标准，以手术切取组织的病理结果和/或AVS为金标准，APA组诊断性试验阳性60例，阴性23例，IHA组阳性12例，阴性30例，此时体位试验诊断APA的敏感性和特异性分别为72.3%和71.4%。以CT检查为单侧结节诊断APA，AVS/或手术确诊的83例APA患者中CT发现单侧结节患者65例，双侧病变者18例，即CT诊断与经AVS/或手术最终诊断为APA的符合率为78.3%(65/83)。在CT示单侧结节、同时体位试验无反应的患者中，AVS/手术诊断为APA的比例为85.0%（51/60）。 结论 对于已确诊为原发性醛固症增多症的患者，采用肾上腺CT联合体位试验分析可增加APA诊断的准确性。
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| 关 键 词： | 原发性醛固酮增多症 醛固酮瘤 特发性醛固酮增多症 体位试验 肾上腺CT |
| 收稿时间： | 2019-05-25 |
The Value of Postural Stimulation Test Combined with Adrenal CT in the Diagnosis of Aldosterone-producing Adenoma |
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| LUO Pan-yu,CHEN Shi-han,YU Ye-rong. The Value of Postural Stimulation Test Combined with Adrenal CT in the Diagnosis of Aldosterone-producing Adenoma[J]. Journal of Sichuan University. Medical science edition, 2020, 51(1): 87-91. DOI: 10.12182/20200160604 |
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| Authors: | LUO Pan-yu CHEN Shi-han YU Ye-rong |
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| Affiliation: | Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China |
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| Abstract: | Objective Adrenal vein sampling (AVS) and pathological report were selected as gold standard to assess the value of adrenal CT scan combined with postural stimulation test in diagnosing aldosterone-producing adenoma. Methods The clinical data of primary aldosteronism (PA) patients including aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) were retrospectively collected in the West China Hospital of Sichuan University. The sensitivity and specificity of adrenal CT scan combined with postural stimulation test in diagnosing APA were studied. Results A total of 83 APA patients and 42 IHA patients were enrolled in this study. ROC curve was plotted with increase percentage of serum aldosterone in upright position compared with recumbent position. The optimal cutoff point for APA diagnosis by postural stimulation test was 11%, and the percentage less than 11% was taken as a positive result. The patients were diagnosed by postural stimulation test, with 60 cases positive and 23 cases negative in APA patients and 12 cases positive and 30 cases negative in IHA patients. When AVS and pathological report were selected as the gold standard, the sensitivity and specificity of postural stimulation test in diagnosing APA were 72.3% and 71.4% respectively. Among the 83 APA patients, 65 patients with unilateral nodules and 18 patients with bilateral nodules were diagnosed by CT scan. The coincidence rate in APA diagnosis between CT scan and AVS or pathological report was 78.3% (65/83). Among the 60 patients with positive result in postural stimulation test, who were diagnosed bilateral nodules by CT scan, 51 patients were diagnosed as APA by AVS or pathological report (51/60). Conclusion Adrenal CT combined with postural test can increase the diagnostic accuracy of APA patients. |
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