摘要
目的评价多种临床试验方法对肾上腺腺瘤(APA)和增生(BAH)的敏感性和特异性。方法在124例临床确诊的原发性醛固酮增多症(PA)患者中进行体位激发试验(PST)、赛庚啶抑制试验、肾上腺静脉插管检查(VSA),并与影像学检查、术后病理结果进行比较。结果①APA组的血钾显著低于BAH组(P<0.001),血、尿醛固酮则显著增高(P<0.05)。②PST:22例APA患者中,12例血醛固酮升幅>30%,7例升幅<30%,较试验前下降者有3例;7例BAH中有4例升幅>30%。③赛庚啶试验:BAH中反应者占69.2%(18/26例),APA中反应者占50.0%(20/40例)。④VSA:11例行VSA的APA患者中,9例APA插管结果与术后病理结果相符,另2例示醛固酮不呈一侧优势分泌;3例BAH插管结果均与影像学检查结果相符。结论PST及赛庚啶试验在APA及BAH中有相当一部分重叠,对两者的鉴别价值有限。影像学未能发现明显占位性病变者可进行VSA,如结果提示一侧病变则考虑手术治疗;如提示双侧病变,则予药物治疗,并进行随访。
Objective To evaluate the sensitivity and specificity of various diagnostic methods for adrenal adenoma and hyperplasia of primary hyperaldosteronism（PA）. Methods 124 patients diagnosed clinically with PA were examined by postural stimulating test （PST）, cyproheptadine test and adrenal venous sampling （AVS）. The data were compared with CT and postoperative pathologic diagnosis. Results ①The patients with APA had lower serum potassium, higher plasma and urinary aldosterone. ②The PST in 7 patients with BAH and 22 patients with APA showed that the plasma aldosterone after PST in 4 patients with BAH increased by more than 30%, there were 12 cases in patients with APA. ③The cyproheptadine test was carried out in 26 patients with BAH and 40 patients with APA. It was found that the plasma aldosterone in 18 patients with BAH and 20 patients with APA decreased more than 30% in co with basic plasma aldosterone. ④The AVS was done in 11 patients with APA and 3 patients with BAH. The diagnosis of adenoma by AVS in 9 patients was concordance with the postoperative pathologic diagnosis. The diagnosis of hyperplasia by AVS in all 3 patients was in accordance with CT scanning. Conclusions The results of PST and cyproheptadine test showed considerable existance of overlapping of adrenal adenoma and hyperplasia cases, but of little value in differential diagnosis. Adrenal venous sampling can be performed in patients with no obvious lesion shown by CT or ultrasonography. If the lesion is unilateral, operation should be considered, if it is bilateral , drug therapy can be instituted. （Shanghai Med J, 2006,29：78-80）.
出处
《上海医学》
CAS
CSCD
北大核心
2006年第2期78-80,共3页
Shanghai Medical Journal
