Laurent Irakoze, Astère Manirakiza, Zheng Fengfan, Chen Xiangjun, Yang Jun, Cheng Qingfeng, Li Qifu
Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University.
Kamenge military hospital, Ministry of Public Health and Fighting AIDS, Bujumbura, Burundi.
J Clin Endocrinol Metab. 2018 Nov 6. doi: 10.1210/jc.2018-01324.
Adrenal venous sampling (AVS) with or without adrenocorticotropic hormone (ACTH) stimulation is the test of choice to identify patients with a surgically curable subtype of primary aldosteronism (PA). Whether AVS with ACTH stimulation is more effective than AVS without ACTH stimulation remains controversial.
To compare the effectiveness of AVS with ACTH stimulation and AVS without ACTH stimulation in patients with PA.
The Cochrane Library, PubMed, Embase, and Web of Science databases were searched to identify relevant articles. All cohort studies comparing the 2 techniques (AVS with ACTH stimulation and AVS without ACTH stimulation in patient with PA) were included in the analysis.
A total of 14 studies met the inclusion criteria, and they were analyzed. AVS with ACTH stimulation did not significantly reduce the number of incorrect lateralization more than AVS without ACTH stimulation in patients with PA [OR: 0.76, 95% confidence interval (CI): 0.36, 1.59; P=0.47]. AVS with ACTH stimulation significantly reduced the number of unsuccessful cannulations of both adrenal veins more than AVS without ACTH stimulation in patients with PA (OR: 0.26, 95% CI: 0.17, 0.40; P<0.00001). For subgroup analyses, it also significantly reduced the number of unsuccessful cannulations of left adrenal vein and right adrenal vein (OR: 0.14, 95% CI: 0.06, 0.33; P<0.00001 and OR: 0.30, 95% CI: 0.12, 0.71; P=0.007, respectively).
AVS with ACTH stimulation can significantly reduce the number of unsuccessful cannulations, without significantly reducing the number of incorrect lateralization. Further studies are still needed to verify these findings.
肾上腺静脉采血（AVS）无论有无促肾上腺皮质激素（ACTH）刺激，都是识别可通过手术治愈的原发性醛固酮增多症（PA）亚型患者的首选检查方法。ACTH刺激下的AVS是否比无ACTH刺激的AVS更有效仍存在争议。
比较ACTH刺激下的AVS与无ACTH刺激的AVS在PA患者中的有效性。
检索Cochrane图书馆、PubMed、Embase和Web of Science数据库以识别相关文章。纳入所有比较这两种技术（PA患者中ACTH刺激下的AVS与无ACTH刺激的AVS）的队列研究进行分析。
共有14项研究符合纳入标准并进行了分析。在PA患者中，ACTH刺激下的AVS相比无ACTH刺激的AVS，并未显著减少错误定位的数量[比值比（OR）：0.76，95%置信区间（CI）：0.36，1.59；P = 0.47]。在PA患者中，ACTH刺激下的AVS相比无ACTH刺激的AVS，显著减少了双侧肾上腺静脉插管失败的数量（OR：0.26，95% CI：0.17，0.40；P < 0.00001）。对于亚组分析，它也显著减少了左肾上腺静脉和右肾上腺静脉插管失败 的数量（分别为OR：0.14，95% CI：0.06，0.33；P < 0.00001和OR：0.30，95% CI：0.12，0.71；P = 0.007）。
ACTH刺激下的AVS可显著减少插管失败的数量，但并未显著减少错误定位的数量。仍需进一步研究以验证这些发现。
