原发性醛固酮增多症的分型诊断

目的 探讨用于原发性醛固酮增多症(原醛症)分型诊断检查方法的价值.方法 收集本院近7年来57例临床确诊的原醛症患者醛固酮瘤22例,特发性醛固酮增多症(特醛症)26例,原发性肾上腺增生9例],检测患者的血电解质、血浆肾素活性及血、尿醛固酮,将结果与19例原发性高血压患者对照.再通过肾上腺CT、体位激发试验及肾上腺静脉采血检查对原醛症患者分型并随访.结果 (1)醛固酮瘤患者血压及血、尿醛固酮较特醛症患者高,血钾及血浆肾素活性则低,而原发性肾上腺增生患者临床及生化改变介于两者之间.肾上腺CT检查在原醛症分型诊断中的符合率为醛固酮瘤86.4%,特醛症73.1%,原发性肾上腺增生22.2%;肾上腺静脉采血检查以两侧醛固酮之比作为判定标准时符合率为86.4%、80.8%和77.8%,以醛固酮与皮质醇之比为判定标准则符合率分别为95.5%、92.3%及100.0%.(2)醛固酮瘤及原发性肾上腺增生患者术后随访血醛固酮均下降,血压恢复正常者分别为22.7%及44.9%,血钾恢复正常者为83.3%及100.0%,而特醛症患者随访中各项测值无明显变化,另有33.3%诊断时血钾正常的患者随访中出现低血钾.结论 原醛症的分型诊断需依靠多种检查手段综合分析,单纯依赖影像学检查或体位激发试验并不可靠,肾上腺静脉采血检查可作为影像学检查的补充,用两侧醛固酮与皮质醇的比值分析较单纯比较两侧醛固酮之比更为可靠;醛固酮瘤及原发性肾上腺增生患者术后临床及生化测值均得以明显改善,而特醛症患者随访中无明显变化.

Differential diagnosis of subtypes in primary aldosteronism

Objective To evaluate the tests in differential diagnosis of subtypes in patients with primary aldosteronism. Methods Fifty-seven patients in the past 7 years chnically diagnosed as primary aldosteronism 22cases of aldosterone-producing adenoma (APA), 26 idiopathic hyperaldosteronism (IHA) and 9 primary adrenal hyperplasia (PAH)] were selected. The plasma potassium, basic and upright plasma renin activity, plasma and urinary aldosterone were determined. 19 patients with essential hypertension served as control. All patients with primary aldosteronism underwent adrenal CT, postural stimuhtion test (PST) and adrenal venous sampling (AVS) to differentiate the subtypes. The clinical and laboratory data were followed up during survey. Results (1) The patients with APA had higher blood pressure and aldosterone level in plasma or urine, but lower plasma potassium and plasma renin activity than those with IHA. In PAH group, these parameters were in the ranges between APA group and IHA group. For the diagnosis of APA, IHA and PAH, the coincidences were 86.4%, 73.1% and 22.2% by adrenal CT, 86.4%, 80.8% and 77.8% by the ratio of aldosterone in both sides of AVS and 95.5%,92.3% and 100.0% by the ratio of aldosterone to cortisol in beth sides, respectively. (2) The plasmaaldosterone, systohc and diastolic blood pressure were decreased after operation in the patients of APA and PAH,and no significant changes were found in patients with IHA. Conclusion The abnormal laboratory findings in patients with APA axe more evident than those in IHA. The result of PST is overlapping considerably in cases ofAPA and IHA. Adrenal venous samphng yields a high coincidence, which should be done in patients with negative CT scanning. The ratio of aldosterone to eortisol in AVS is more reliable. The clinical and laboratory data,especially plasma potassium will be improved after operation in patients with APA and PAH. But there is no change in patients with IHA during the follow-up period.