部分成功的肾上腺静脉采血情况下的原发性醛固酮增多症亚型分型
Primary aldosteronism subtyping in the setting of partially successful adrenal vein sampling.
作者信息
Lee Seung-Eun, Park Sung Woon, Choi Min Sun, Kim Gyuri, Yoo Jee Hee, Ahn Jiyeon, Jun Ji Eun, Park Hong Suk, Hyun Dongho, Cho Sung Ki, Ko Seong Eun, Kim Beom-Jun, Kim Jong Woo, Yoon Hyun-Ki, Koh Jung-Min, Lee Seung Hun, Kim Jae Hyeon
机构信息
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Gangnam-gu, Seoul, Republic of Korea.
出版信息
Ther Adv Endocrinol Metab. 2021 Feb 13;12:2042018821989239. doi: 10.1177/2042018821989239. eCollection 2021.
BACKGROUND AND AIMS
Frequent failure of adrenal vein (AV) cannulation is a major obstacle to the universal use of adrenal vein sampling (AVS) for subtyping primary aldosteronism (PA). This study aimed to confirm and modify the value of a previously reported AVS parameter for PA subtyping in the case of cannulation failure on one side.
METHODS
Successfully catheterized AVS studies in 157 patients (121 patients as a derivation cohort and 36 patients as a validation cohort) from two tertiary hospitals were retrospectively reviewed. The AV/inferior vena cava (IVC) index was defined by dividing the aldosterone/cortisol ratio (ACR) of AV by the ACR of the IVC. Cutoff values for lateralized PA were obtained from two methods: scatterplots and the values corresponding to Youden's index in receiver operating characteristic (ROC) curves, on the assumption of catheterization failure on one side.
RESULTS
Due to multiple samplings in a single AVS procedure, 252 left AV/IVC ratios (LIRs) and 272 right AV/IVC ratios (RIRs) were calculated. of LIR >5.4 or <0.5 predicted unilateral PA with a sensitivity of 42.1% and a specificity of 98.6%. of RIR <0.5 or >7.0 showed a sensitivity of 55.1% and a specificity of 98.6%. of LIR ⩽0.8 or >3.1 predicted unilateral PA with a sensitivity of 82.5% and a specificity of 69.6%. of RIR ⩽0.8 or >3.9 resulted in 87.4% sensitivity and 80.7% specificity.
CONCLUSION
In the case of unilateral AVS failure, the AV/IVC index may help in diagnosing PA subtype.
背景与目的
肾上腺静脉（AV）插管频繁失败是原发性醛固酮增多症（PA）亚型分型中肾上腺静脉采样（AVS）广泛应用的主要障碍。本研究旨在确认并修正先前报道的AVS参数在一侧插管失败情况下对PA亚型分型的价值。
方法
回顾性分析了来自两家三级医院的157例患者（推导队列121例，验证队列36例）成功进行导管插入术的AVS研究。AV/下腔静脉（IVC）指数定义为AV的醛固酮/皮质醇比值（ACR）除以IVC的ACR。假设一侧插管失败，通过两种方法获得单侧PA的临界值：散点图法和受试者操作特征（ROC）曲线中与约登指数对应的数值。
结果
由于在单次AVS操作中进行了多次采样，计算出252个左AV/IVC比值（LIR）和272个右AV/IVC比值（RIR）。LIR＞5.4或＜0.5预测单侧PA的敏感性为42.1%，特异性为98.6%。RIR＜0.5或＞7.0的敏感性为55.1%，特异性为98.6%。LIR≤0.8或＞3.1预测单侧PA的敏感性为82.5%，特异性为69.6%。RIR≤0.8或＞3.9的敏感性为87.4%，特异性为80.7%。
结论
在单侧AVS失败的情况下，AV/IVC指数可能有助于诊断PA亚型。
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