Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C.
Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon.
J Vasc Interv Radiol. 2019 Sep;30(9):1335-1342.e1. doi: 10.1016/j.jvir.2019.04.039. Epub 2019 Jul 30.
To assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma.
A systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated.
A total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (-29.06 mm Hg; 95% confidence interval [CI], -33.93 to -24.19), DBP (-16.03 mm Hg; 95% CI, -18.33 to -13.73), and the number of antihypertensive medications used (-1.43; 95% CI, -1.97 to -0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration.
Thermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results.
评估热消融治疗醛固酮分泌性肾上腺腺瘤的疗效。
对 PubMed 和 CINAHL 数据库进行系统检索，以确定热消融治疗肾上腺腺瘤的研究。采用随机效应荟萃分析模型比较以下结局的治疗前后值：收缩压（SBP）、舒张压（DBP）、降压药物的使用以及生化参数（血浆醛固酮水平、醛固酮/肾素比值和血钾水平）。还评估了高血压（HTN）的缓解率和改善率。
共纳入 7 项研究的 89 例患者进行分析。消融后平均随访时间为 45.8 个月。汇总数据分析显示 SBP（-29.06mmHg；95%置信区间[CI]，-33.93 至-24.19）、DBP（-16.03mmHg；95%CI，-18.33 至-13.73）和降压药物使用数量（-1.43；95%CI，-1.97 至-0.89）均有显著下降。所有研究中，消融后生化参数均恢复正常范围。HTN 状态的缓解或改善累积率为 75.3%。元回归分析显示，消融后血压变化或血清醛固酮水平与研究随访时间之间无统计学显著关联。
热消融治疗醛固酮分泌性肾上腺腺瘤可有效控制血压、减少降压药物的使用并使激素分泌正常化。需要进一步高质量的证据来证实这些结果。
