探讨促肾上腺皮质激素兴奋在肾上腺静脉取血中的应用价值

目的:探讨促肾上腺皮质激素(ACTH)兴奋在肾上腺静脉取血(AVS)中的应用价值。方法:纳入完成常规AVS和ACTH兴奋的AVS，且至少有一种AVS双侧肾上腺静脉插管成功的原发性醛固酮增多症(原醛症)患者。计算选择指数(SI)、优势侧指数(LI)，比较ACTH兴奋与否对插管成功率及优势侧判断的影响。结果:共纳入73名原...

Effect of adrenocorticotropic hormone stimulation during adrenal vein sampling

Objective Aimed to investigate the value of adrenocorticotropic hormone(ACTH)stimulation in adrenal venous blood sampling(AVS).Methods Patients who diagnosed as primary aldosteronism(PA)and completed successful bilateral cannulation judged by selection index(SI)for routine and(or)ACTH stimulation AVS were enrolled.The lateralization index(LI)was calculated to compare the effect of ACTH stimulation on AVS cannulation success rate and lateralization judgment.Results A total of 73 patients with PA were enrolled in the study,of whom 28 were confirmed as aldosterone producing adenoma(APA)after unilateral adrenalectomy.Cortisol and aldosterone in peripheral and adrenal veins were significantly increased after ACTH stimulation.The left SI was increased from 6.5(3.0-13.6)to 26.8(16.9-40.3)(P<0.01)and the right SI from 20.8(4.8-34.8)to 57.6(35.7-80.9)(P<0.01)after ACTH stimulation.There was no significant difference on LI before and after ACTH stimulation[7.7(2.3-19.6)vs 5.6(1.9-14.6),P=0.14].The success rates of left and right adrenal cannulation were increased by 15%and 10%respectively after ACTH stimulation.For 57 patients who were determined in successful cannulation by both routine and ACTH stimulation AVS,27 patients were determined to have lateralization by both AVS methods,21 patients were determined to have bilateralization,and the consistency of lateralization by both AVS methods was 84%(48/57).Among the 28 patients who were confirmed to be APA after unilateral adrenalectomy,the correct rate of lateralization by both AVS methods was 89%(25/28).Conclusion ACTH stimulation is able to improve the success rate of bilateral adrenal vein cannulation,and is helpful to judge AVS results.For patients with successful cannulation,there is no significant difference in lateralization judgment for routine and ACTH stimulation AVS.