原醛症六例临床分析及两种分型预测评分系统的应用-现代医学

原醛症六例临床分析及两种分型预测评分系统的应用

单位：1. 南京市溧水区人民医院/东南大学附属中大医院溧水分院内分泌科, 江苏南京 211200;
2. 南京市溧水区人民医院/东南大学附属中大医院溧水分院介入科, 江苏南京 211200;
3. 东南大学附属中大医院内分泌科, 江苏南京 210009

关键词：原发性醛固酮增多症肾上腺静脉采血分型评分系统

分类号：R586.9

出版年·卷·期（页码）：2024·52·第一期（90-95）

摘要：

目的：分析6例原发性醛固酮增多症(PA)患者的临床特征、肾上腺静脉采血(AVS)结果及两种PA分型预测评分系统的应用价值，以期提高临床医师对该病的认识和诊治水平。方法：收集2022年3月至2023年4月在南京市溧水区人民医院诊断为PA并行AVS的6例患者的一般临床资料及诊治情况进行回顾性分析，并结合已发表文献评价SPACE及CLR评分系统的应用价值。结果：6例患者平均年龄50岁，均表现为高血压，4例合并低血钾。所有患者立位血浆醛固酮与肾素比值(ARR)均高于常用切点，确诊试验均为阳性，双侧AVS成功率50%。与既往5年国内发表的10篇个案汇总分析，SPACE评分系统诊断UPA的阳性预测值100%，阴性预测值50%，可使41.6%的患者避免行AVS，CLR与SPACE评分系统预测PA分型的一致率为75%。结论：对于PA患者，如无法进行AVS或AVS仅单侧成功，可结合SPACE或CLR评分系统，以使部分患者在免于进行初次或再次AVS的情况下得到正确的治疗。

Objective: To analyze the clinical features of 6 patients with primary aldosteronism(PA), the results of adrenal venous sampling(AVS), and the application value of two PA subtyping predictive scoring systems in order to improve the understanding, diagnosis and treatment of the disease among clinicians. Methods: The general clinical data, diagnosis and treatment of 6 patients diagnosed with PA and underwent AVS in Nanjing Lishui People's Hospital from March 2022 to April 2023 were retrospectively analyzed, and the application value of SPACE and CLR scoring systems were evaluated combined with published papers. Results: All the 6 patients with an average age of 50 years presented with hypertension, and 4 of the 6 with hypokalemia. The upright plasma aldosterone-to-renin ratio(ARR) in all patients exceeded the usual cut-off point, the confirmatory tests were positive, and the success rate of bilateral AVS was 50%. Along with 10 cases published in China in the past 5 years, the SPACE scoring system displayed a positive/negative predictive value of 100%/50%, avoiding AVS in 41.6%of patients. The agreement rate of CLR and SPACE scoring system in predicting PA subtyping was 75%. Conclusion: For patients with PA, if AVS is unavailable or of unilateral success, the SPACE or CLR scoring systems can be integrated in clinical practice to enable some patients to be properly treated in the cases of avoiding initial or repetitive AVS.

参考文献：

[1] REINCKE M,BANCOS I,MULATERO P,et al.Diagnosis and treatment of primary aldosteronism[J].Lancet Diabetes Endo,2021,9(12):876-892.
[2] WILLIAMS T A,REINCKE M.Pathophysiology and histopathology of primary aldosteronism[J].Trends Endocrinol Metab,2022,33(1):36-49.
[3] 中华医学会内分泌学分会.原发性醛固酮增多症诊断治疗的专家共识(2020版)[J].中华内分泌代谢杂志，2020，36(9)：727-736.
[4] 苗新宇，陈康，曾正陪.肾上腺静脉采血在原发性醛固酮增多症诊治中的历史、现状与争议[J].中华内科杂志，2022，61(10)：1085-1090.
[5] BURRELLO J,BURRELLO A,PIERONI J,et al.Development and validation of prediction models for subtype diagnosis of patients with primary aldosteronism[J].J Clin Endocrinol Metab,2020,105(10):dgaa379.
[6] BURRELLO J,BURRELLO A,PIERONI J,et al.Prediction of hyperaldosteronism subtypes when adrenal vein sampling is unilaterally successful[J].Eur J Endocrinol,2020,183(6):657-667.
[7] NG E,GWINI S M,LIBIANTO R,et al.Aldosterone,renin,and aldosterone-to-renin ratio variability in screening for primary aldosteronism[J].J Clin Endocrinol Metab,2022,108(1):33-41.
[8] STOWASSER M,AHMED A H,COWLEY D,et al.Comparison of seated with recumbent saline suppression testing for the diagnosis of primary aldosteronism[J].J Clin Endocrinol Metab,2018,103(11):4113-4124.
[9] LIU B,HU J,SONG Y,et al.Seated saline suppression test is comparable with captopril challenge test for the diagnosis of primary aldosteronism:a prospective study[J].Endocr Pract,2021,27(4):326-333.
[10] SONG Y,YANG S,HE W,et al.Confirmatory tests for the diagnosis of primary aldosteronism:a prospective diagnostic accuracy study[J].Hypertension,2018,71(1):118-124.
[11] WILLIAMS T A,BURRELLO J,SECHI L A,et al.Computed tomography and adrenal venous sampling in the diagnosis of unilateral primary aldosteronism[J].Hypertension,2018,72(3):641-649.
[12] OHNO Y,NARUSE M,BEUSCHLEIN F,et al.Adrenal venous sampling-guided adrenalectomy rates in primary aldosteronism:results of an international cohort(AVSTAT)[J].J Clin Endocrinol Metab,2021,106(3):e1400-e1407.
[13] 董徽，蒋雄京，彭猛，等.经肘正中静脉行分侧肾上腺静脉取血的可行性与安全性研究:附50例首次报告[J].中华高血压杂志，2016，24(2)：158-162.
[14] LIU W,ZHANG J,YANG Y,et al.Effect of adrenocorticotropic hormone stimulation during simultaneous bilateral adrenal vein sampling in primary aldosteronism[J].Horm Metab Res,2021,53(6):364-370.
[15] KVPERS E M,AMAR L,RAYNAUD A,et al.A clinical prediction score to diagnose unilateral primary aldosteronism[J].J Clin Endocrinol Metab,2012,97(10):3530-3537.
[16] ZHANG Y,NIU W,ZHENG F,et al.Identifying unilateral disease in Chinese patients with primary aldosteronism by using a modified prediction score[J].J Hypertens,2017,35(12):2486-2492.

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