Utsumi Takanobu, Kamiya Naoto, Endo Takumi, Yano Masashi, Kamijima Shuichi, Kawamura Koji, Imamoto Takashi, Naya Yukio, Ichikawa Tomohiko, Suzuki Hiroyoshi
Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan,
World J Surg. 2014 Oct;38(10):2640-4. doi: 10.1007/s00268-014-2612-1.
Primary aldosteronism is the most common curable cause of secondary hypertension. Despite resection, however, many patients with primary aldosteronism continue to require antihypertensive drugs to control their blood pressure. Although many patients with primary aldosteronism want to know the postoperative probability of hypertension cure before surgery, there are no predictive models calculating its probability. We therefore developed a nomogram to predict hypertension cure in patients with primary aldosteronism after laparoscopic adrenalectomy.
We retrospectively surveyed 132 Japanese patients with primary aldosteronism who were treated by unilateral laparoscopic adrenalectomy. Hypertension cure was defined as normal blood pressure (<140/90 mmHg) without antihypertensive drugs 6 months postoperatively. We developed a novel nomogram that postoperatively predicted cured hypertension in 105 (80 %) randomly selected patients and validated it with the remaining 27 (20 %).
At 6 months, blood pressure had normalized in 42 % of patients without antihypertensive drugs. Duration of hypertension, preoperative number of antihypertensive drug classes, age, and sex were incorporated into a novel nomogram as independent predictors of hypertension cure. The value of the area under the receiver operating characteristics curve for this nomogram was 0.83-which was significantly higher than that of the Aldosteronoma Resolution Score-on internal validation.
We developed the first nomogram that can accurately predict postoperative hypertension cure in patients with primary aldosteronism. This nomogram can help clinicians calculate the probability of postoperative hypertension cure in patients with primary aldosteronism and objectively inform them of their hypertension outcome before laparoscopic adrenalectomy.
原发性醛固酮增多症是继发性高血压最常见的可治愈病因。然而，尽管进行了手术切除，许多原发性醛固酮增多症患者仍需使用降压药物来控制血压。虽然许多原发性醛固酮增多症患者想在手术前了解术后高血压治愈的概率，但尚无计算该概率的预测模型。因此，我们开发了一种列线图来预测原发性醛固酮增多症患者行腹腔镜肾上腺切除术后高血压的治愈情况。
我们回顾性调查了132例接受单侧腹腔镜肾上腺切除术治疗的日本原发性醛固酮增多症患者。高血压治愈定义为术后6个月血压正常（<140/90 mmHg）且无需使用降压药物。我们开发了一种新型列线图，对105例（80%）随机选择的患者术后高血压治愈情况进行预测，并使用其余27例（20%）患者进行验证。
6个月时，42%的患者在未使用降压药物的情况下血压恢复正常。高血压病程、术前使用降压药物的种类数、年龄和性别被纳入新型列线图，作为高血压治愈的独立预测因素。该列线图在内部验证中的受试者操作特征曲线下面积值为0.83，显著高于醛固酮瘤消退评分。
我们开发了首个能够准确预测原发性醛固酮增多症患者术后高血压治愈情况的列线图。该列线图可帮助临床医生计算原发性醛固酮增多症患者术后高血压治愈的概率，并在腹腔镜肾上腺切除术前行客观告知其高血压预后情况。
