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计算机断层扫描结合确证试验用于诊断醛固酮瘤。

Computed tomography combined with confirmatory tests for the diagnosis of aldosterone-producing adenoma.

机构信息

Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

出版信息

Endocr J. 2021 Mar 28;68(3):299-306. doi: 10.1507/endocrj.EJ20-0395. Epub 2020 Oct 23.

Abstract

Primary aldosteronism (PA) is the most common cause of secondary hypertension, and a simpler non-invasive method for identification of aldosterone-producing adenoma (APA) is required to improve the standard of medical treatment for PA patients. We retrospectively analyzed the clinical data of hypertensive patients with an aldosterone/renin ratio (ARR) ≥30 (ng/dL)/(ng/mL/h), and surgical and/or adrenal venous sampling (AVS) results served as the gold standard for APA diagnosis. The study aimed to determine whether positive CCT and SIT results plus a unilateral adrenal nodule found by CT allow unambiguous identification of an APA with high diagnostic specificity. Clinical data from 71 APA and 47 non-APA patients were collected, and logistic regression analysis was performed to construct models. Receiver operating characteristic (ROC) curves were used to analyze the efficacy of diagnostic tests. The areas under the ROC curves (AUCs) were similar between the post-SIT plasma aldosterone concentration (PAC) and post-CCT PAC (p > 0.05). The optimal post-SIT and post-CCT PAC cutoff values were 17.2 and 21.2 ng/dL, respectively. Positive CT findings combined with a post-SIT PAC >17.2 ng/dL or post-CCT PAC >21.2 ng/dL provided specificities of 97.8% and 95.7% for predicting APA, respectively. Logistic diagnostic models 1 (M1, CT finding + post-SIT PAC) and 2 (M2, CT finding + post-CCT PAC) were built, which showed equivalent diagnostic value (AUC = 0.959 and 0.932, respectively) (p > 0.05). The models combining CT findings with post-SIT PACs or post-CCT PACs represent an easier method to distinguish APA patients from other hypertensive patients with positive upright ARR results, especially in primary care where AVS may be unavailable.

摘要

原醛症(PA)是继发性高血压最常见的病因,需要一种更简单的非侵入性方法来识别醛固酮瘤(APA),以提高 PA 患者的治疗标准。我们回顾性分析了醛固酮/肾素比值(ARR)≥30(ng/dL)/(ng/mL/h)的高血压患者的临床资料,以手术和/或肾上腺静脉采样(AVS)结果作为 APA 诊断的金标准。本研究旨在确定阳性 CCT 和 SIT 结果加上 CT 发现的单侧肾上腺结节是否能明确识别具有高诊断特异性的 APA。收集了 71 例 APA 和 47 例非 APA 患者的临床资料,并进行了逻辑回归分析以构建模型。使用受试者工作特征(ROC)曲线分析诊断试验的疗效。ROC 曲线下面积(AUC)在 SIT 后血浆醛固酮浓度(PAC)和 CCT 后 PAC 之间相似(p>0.05)。SIT 后和 CCT 后最佳 PAC 截断值分别为 17.2 和 21.2 ng/dL。阳性 CT 发现联合 SIT 后 PAC>17.2 ng/dL 或 CCT 后 PAC>21.2 ng/dL 对预测 APA 的特异性分别为 97.8%和 95.7%。构建了逻辑诊断模型 1(M1,CT 发现+SIT 后 PAC)和 2(M2,CT 发现+CCT 后 PAC),其诊断价值相当(AUC=0.959 和 0.932)(p>0.05)。结合 CT 发现和 SIT 后 PAC 或 CCT 后 PAC 的模型代表了一种更简单的方法,可以将 APA 患者与其他阳性直立 ARR 结果的高血压患者区分开来,尤其是在可能无法进行 AVS 的初级保健中。

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