分泌皮质醇肾上腺腺瘤患者腹腔镜肾上腺切除术后心血管风险改善：一项回顾性队列研究
Cardiovascular risk improvement after laparoscopic adrenalectomy in patients with cortisol-secreting adrenal adenoma, a retrospective cohort study.
作者信息
Wonglhaw Worapat, Santi-Ngamkun Apirak, Ratchanon Supoj, Usawachintachit Manint, Sowanthip Dutsadee, Panumatrassamee Kamol
机构信息
Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
出版信息
Gland Surg. 2024 Nov 30;13(11):2128-2136. doi: 10.21037/gs-24-398. Epub 2024 Nov 26.
BACKGROUND
Cushing syndrome increases morbidity and mortality, which is mainly caused by cardiovascular disorders. This study reports the cardiovascular risk outcomes at 3, 6, and 12 months after unilateral laparoscopic adrenalectomy in cortisol-secreting adrenal tumor and to identify the preoperative parameters predicting the resolution of cardiovascular risk factors after surgery.
METHODS
All clinical data of patients with unilateral cortisol-secreting adrenal tumors who underwent laparoscopic adrenalectomy in King Chulalongkorn Memorial Hospital between 2001-2022 were retrospectively reviewed. Analyzed baseline parameters included age, gender, body mass index (BMI), tumor size, and laterality. Systolic and diastolic blood pressure (DBP), fasting blood sugar (FBS), hemoglobin A1C (HbA1C), lipid profiles, and serum cortisol level were evaluated before surgery and at 3, 6, 12 months postoperatively. The resolution rate and predictive factors of hypertension (HT), diabetes, and dyslipidemia after surgery were analyzed.
RESULTS
Forty-five patients were included in this study. The mean [standard deviation (SD)] age was 44.2 (14.7) years. The mean (SD) BMI was 25.9 (5.4) kg/m. The mean (SD) tumor size was 3.1 (1.0) cm. Most of the patients were female (97.8%). After surgery, the resolution rate of HT, dyslipidemia, and obesity were significantly improved after 3 months (P<0.001, P=0.01, and 0.02 respectively). Diabetes mellitus (DM) significantly improved at 1 year after surgery (P<0.001). From multivariable analysis, the significant predictive factors for the resolution of HT were age [odds ratio (OR) 0.95; 95% confidence interval (CI): 0.91-0.99, P=0.01], BMI (OR 0.85; 95% CI: 0.77-0.95, P=0.003) and systolic blood pressure (SBP) (OR 0.97; 95% CI: 0.94-1, P=0.03). Preoperative serum cortisol was the significant predictive factor for the improvement of diabetes (OR 1.12; 95% CI: 1.01-1.25, P=0.04) and serum cholesterol was the predictive factor for the improvement of dyslipidemia (OR 0.97; 95% CI: 0.96-0.99, P=0.003) after surgery.
CONCLUSIONS
Adrenalectomy significantly improves the cardiovascular risk factors in cortisol-secreting adrenal adenoma.
背景
库欣综合征会增加发病率和死亡率，主要由心血管疾病引起。本研究报告了分泌皮质醇的肾上腺肿瘤患者单侧腹腔镜肾上腺切除术后3个月、6个月和12个月时的心血管风险结果，并确定预测术后心血管危险因素消退的术前参数。
方法
回顾性分析2001年至2022年在朱拉隆功国王纪念医院接受腹腔镜肾上腺切除术的单侧分泌皮质醇肾上腺肿瘤患者的所有临床资料。分析的基线参数包括年龄、性别、体重指数（BMI）、肿瘤大小和肿瘤位置。在手术前以及术后3个月、6个月、12个月评估收缩压和舒张压（DBP）、空腹血糖（FBS）、糖化血红蛋白（HbA1C）、血脂谱和血清皮质醇水平。分析术后高血压（HT）、糖尿病和血脂异常的缓解率及预测因素。
结果
本研究纳入45例患者。平均[标准差（SD）]年龄为44.2（14.7）岁。平均（SD）BMI为25.9（5.4）kg/m²。平均（SD）肿瘤大小为3.1（1.0）cm。大多数患者为女性（97.8%）。手术后，3个月后HT、血脂异常和肥胖的缓解率显著改善（分别为P<0.001、P=0.01和0.02）。糖尿病（DM）在术后1年显著改善（P<0.001）。多变量分析显示，HT缓解的显著预测因素为年龄[比值比（OR）0.95；95%置信区间（CI）：0.91-0.99，P=0.01]、BMI（OR 0.85；95%CI：0.77-0.95，P=0.003）和收缩压（SBP）（OR 0.97；95%CI：0.94-1，P=0.03）。术前血清皮质醇是糖尿病改善的显著预测因素（OR 1.12；95%CI：1.01-1.25，P=0.04），血清胆固醇是术后血脂异常改善的预测因素（OR 0.97；95%CI：0.96-0.99，P=0.003）。
结论
肾上腺切除术显著改善分泌皮质醇的肾上腺腺瘤患者的心血管危险因素。
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