经手术病理证实的原发性醛固酮增多症102例临床分析

目的在经手术病理证实的原发性醛固酮增多症(PA)患者中评价术前各项诊断筛查方法的临床价值。方法回顾性分析经手术病理证实的102例PA患者的临床特征、生化资料及血浆醛固酮浓度(PAC)、血浆醛固酮与肾素比值(ARR),比较不同指标筛查PA的阳性率,不同试验对PA的确诊率及影像学检查对PA的检出率和诊断符合率。结果在上述患者中:(1)ARR>20 ng/dl·(ng·ml-1·h-1)-1筛查PA的阳性率为86.27%;ARR>20 ng/dl·(ng·ml-1·h-1)-1且PAC>15 ng/dl筛查PA的阳性率为68.63%(P<0.01)。(2)静脉盐水抑制试验和卡托普利抑制试验对PA的确诊率分别为100%和80%(P>0.05)。(3)影像学检查中,CT和MRI对PA的检出率明显高于超声(P<0.01);与术后病理对照,CT对醛固酮腺瘤(APA)和单侧肾上腺皮质增生(UAH)的诊断符合率分别为97.33%和78.26%(P<0.01),MRI对APA和UAH诊断符合率分别为88.89%和75.00%(P>0.05)。结论 ARR>20 ng/dl·(ng·ml-1·h-1)-1筛查PA的阳性率高于ARR>20 ng/dl·(ng·ml-1·h-1)-1联合PAC>15 ng/dl;盐水抑制试验和卡托普利抑制试验都有较高的确诊率;影像学检查中,CT对PA有较高的检出率和诊断符合率,对于分型而言,CT对APA的诊断符合率高于UAH。

Clinical analysis of 102 patients with primary aldosteronism confirmed by postoperative pathology

Objective To evaluate the value of diagnostic methods in primary aldosteronism（PA） confirmed by postoperative pathology. Methods 102 patients with PA confirmed by postoperative Pathology were collected in Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, and analysis the clinical characteristics and biochemical data, serum aldosterone and aldosterone to renin ratio（ARR） was calculated. Comparison of screening tests, confirmatory tests and adrenal imaging in diagnosis of primary aldosteronism. Results（1）The positive screening rate was 86.27% in ARR20 ng/dl·（ng·ml-1·h-1）-1（the follows same as this unit） and 68.63% in ARR20 ng/dl·（ng·ml-1·h-1）-1 combination of PAC15 ng/dl（P0.01）.（2）The diagnostic accuracy was 100% in saline infusion test and 80% in captopril suppression test.（3）Among adrenal imaging examination, CT and MRI detection rate were significantly higher than the ultrasonography. Compared with postoperative pathology, the coincidence of CT was 97.33% in aldosterone-producing adenoma（APA） and 78.26% in unilateral adrenal hyperplasia（UAH）（P0.01）, the coincidence of MRI was 88.89% in APA and 75.00% in UAH（P0.05）. Conclusions ARR20 ng/dl·（ng·ml-1·h-1）-1 has higher positive screening rate than ARR20 combination of PAC15 ng/dl. Both saline infusion test and captopril suppression test might be used as confirmatory tests for diagnosis of PA. CT has the highest detection rate of PA among adrenal imaging examination. With regard to subtype differentiation, the coincidence of CT is higher in APA than in UAH.