肾上腺静脉采血在原发性醛固酮增多症分型诊断中的应用

目的探讨肾上腺静脉采血（AVS）检查在原发性醛固酮增多症（原醛症）分型诊断中的应用价值。方法收集瑞金医院近4年来39例临床确诊的原醛症患者23例特发性醛固酮增多症（特醛症），16例醛固酮瘤]，经肾上腺静脉插管检查，取双侧肾上腺静脉以及肾静脉水平下的下腔静脉血液，测各点醛固酮和皮质醇水平，并将结果与影像学检查、体位激发试验（PST）及术后病理结果进行比较。结果（1）23例特醛症患者体位激发后血醛固酮较基础值均升高；16例醛固酮瘤患者血醛固酮升高者占56．3％（9／16）；（2）特醛症患者肾上腺B超检查符合率为69．6％（16／23），醛固酮瘤患者为56．3％（9／16）；肾上腺CT检查特醛症患者符合率为73．9％（17／23），醛固酮瘤患者为81．3％（13／16）；（3）AVS检查以两侧醛固酮之比作为判定标准时符合率为71．8％，以醛固酮与皮质醇之比为判定标准则达到100％。醛固酮瘤患者生化异常程度较特醛症患者明显。PST在特醛症及醛固酮瘤中有部分重叠；体位激发后血醛固酮升高者不能排除醛固酮瘤，而血醛固酮下降者可诊断为醛固酮瘤。结论单纯依赖影像学检查对于原醛症患者进行分型诊断易发生误诊。AVS检查的准确性高，对于影像学检查未能发现明显占位性病变者须进行该检查以明确诊断；对于AVS结果，用两侧醛固酮与皮质醇的比值之比分析较单纯比较两侧醛固酮之比更为可靠。

Application of adrenal venous sampling in typing diagnosis of primary hyperaldosteronism

Objective To investigate the value of adrenal venous sampling(AVS)in typing diagnosis of primary aldosteronism(PA).Methods Thirty-nine patients diagnosed clinically as PA23 idiopathic hyperaldosteronism(IHA)and 16 aldosterone-producing adenoma(APA)]in the recent four years were examined with AVS for measurement of plasma aldosterone and cortisol levels,and their plasma levels in each adrenal vein and in the infrarenal inferior vena cava were assessed.The data were compared with CT,postural stimulation test (PST)and postoperative pathologic diagnosis.Results (1)The plasma aldosterone level after PST was increased in all of 23 IHA patients and 9 among 16 patients with APA.(2)The coincidence of ultrasonography was 69.6% in IHA(16/23),and 56.3% in APA(9/16).The coincidence of CT was 73.9%(17/23)in IHA,and 81.3%(13/16)in APA.(3)The coincidence of AVS with the ratio of aldosterone in both sides of adrenal was 71.8%,and 100% with the ratio of aldosterone and cortisol in both sides.The anomalies of laboratory data in patients with APA were more evident than those in IHA.The result of PST is overlapping considerably in APA and IHA.However those with elevation of serum aldosterone after PST could not be excluded to have APA,while those with decreased level could be confirmed as having APA.Conclusion AVS shows a high accuracy,and should be performed in patients with a negative CT finding.The analysis of aldosterone/cortisol ratio in AVS is more reliable than bilateral comparison of aldosterone.