Department of Urology, First People's Hospital of Yunnan Province, Kunming, China.
Department Of Urology, Yaan People's Hospital, Yaan, China.
Int J Clin Pract. 2021 Sep;75(9):e14438. doi: 10.1111/ijcp.14438. Epub 2021 Jun 16.
This meta-analysis was performed to compare the effect of adrenal venous sampling with adrenocorticotropic hormone with that without adrenocorticotropic hormone in subjects with primary aldosteronism.
A systematic literature search up to May 2020 was performed and 17 studies were detected with 1878 subjects who had adrenal venous sampling operations. They reported relationships between with and without adrenocorticotropic hormone stimulation during adrenal venous sampling in subjects with primary aldosteronism. We calculated the odds ratio (OR) with 95% confidence intervals (CIs), using the dichotomous method with a random- or fixed-effect model.
Adrenal venous sampling operations with adrenocorticotropic hormone stimulation had statistically significant lower incorrect lateralisation (OR, 0.57; 95% CI, 0.43-0.75, P < .001); lower unsuccessful cannulations in both adrenal veins (OR, 0.35; 95% CI, 0.21-0.58, P < .001); lower unsuccessful cannulations of left adrenal vein (OR, 0.10; 95% CI, 0.06-0.17, P < .001) and lower unsuccessful cannulations of right adrenal vein (OR, 0.25; 95% CI, 0.11-0.54, P < .001) compared with without adrenocorticotropic hormone stimulation in subjects with primary aldosteronism.
Adrenal venous sampling operations with adrenocorticotropic hormone stimulation had significantly lower incorrect lateralisation, unsuccessful cannulations in both adrenal veins, unsuccessful cannulations of the left adrenal vein and unsuccessful cannulations of the right adrenal vein compared with adrenal venous sampling operations without adrenocorticotropic hormone stimulation in subjects with primary aldosteronism. Larger prospective studies are recommended to confirm these findings.
本荟萃分析旨在比较原发性醛固酮增多症患者中使用和不使用促肾上腺皮质激素（adrenocorticotropic hormone，ACTH）的肾上腺静脉采样（adrenal venous sampling，AVS）的效果。
系统检索截至 2020 年 5 月的文献，共检出 17 项研究，纳入 1878 例行 AVS 的原发性醛固酮增多症患者。这些研究报道了原发性醛固酮增多症患者在 AVS 期间使用和不使用 ACTH 刺激时的关系。我们采用二项分类法，使用随机或固定效应模型计算比值比（odds ratio，OR）及其 95%置信区间（confidence interval，CI）。
使用 ACTH 刺激的 AVS 操作具有统计学意义的较低不正确侧化（OR，0.57；95%CI，0.43-0.75，P<0.001）；双侧肾上腺静脉均未成功穿刺（OR，0.35；95%CI，0.21-0.58，P<0.001）；左肾上腺静脉未成功穿刺（OR，0.10；95%CI，0.06-0.17，P<0.001）和右肾上腺静脉未成功穿刺（OR，0.25；95%CI，0.11-0.54，P<0.001）的发生率均低于不使用 ACTH 刺激的 AVS。
与不使用 ACTH 刺激的 AVS 相比，原发性醛固酮增多症患者使用 ACTH 刺激的 AVS 操作具有较低的不正确侧化、双侧肾上腺静脉均未成功穿刺、左肾上腺静脉未成功穿刺和右肾上腺静脉未成功穿刺的发生率。建议开展更大规模的前瞻性研究以证实这些发现。
