Bai Minfu, Zhao Qiuping, Dong Jiajia, Yang Xiaomo, Wang Xiaohui, Gao Chuanyu
Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, 1 Fu Wai Road, Zhengzhou, 451464, China.
Cardiovasc Intervent Radiol. 2025 Jul;48(7):984-989. doi: 10.1007/s00270-025-04005-x. Epub 2025 Apr 2.
Although adrenal vein sampling (AVS) is the standard method for subtype diagnosis in patients with primary aldosteronism (PA), the methods used to sample the adrenal vein are not standardized. The aim of this study was to establish the optimal method for sampling the adrenal vein based on the pathological findings after surgery for PA.
We enrolled 168 consecutive patients who were diagnosed to have PA and underwent AVS at our institution between 2019 and 2023. The impact of sampling by gentle negative pressure (GNP) on the accuracy of diagnosis of the PA subtype was compared with that of sampling by gravity, whereby blood flows out naturally.
AVS was performed successfully on both sides in 139 patients using the two sampling methods. Subtype diagnosis using the two sampling methods was concordant in 128 (92.1%) of the 139 patients and discordant in 11 (7.9%). Among the 11 patients with a discordant subtype diagnosis, unilateral adrenalectomy was performed in three with the right unilateral subtype by gravity and the bilateral subtype by GNP, one with the bilateral subtype by gravity and the right unilateral subtype by GNP, and one with the left unilateral subtype by gravity and the bilateral subtype by GNP. The pathological findings after surgery showed that the false-negative rate was 20% (1/5) with data obtained by the gravity method and 80% (4/5) with data obtained by the GNP method. Bilateral AVS took significantly longer when sampling was performed by the gravity method than when it was performed by GNP (p < 0.01).
The gravity method may be preferable to GNP for AVS in patients with PA.
尽管肾上腺静脉采血（AVS）是原发性醛固酮增多症（PA）患者亚型诊断的标准方法，但肾上腺静脉采血所采用的方法尚未标准化。本研究的目的是根据PA手术后的病理结果确定肾上腺静脉采血的最佳方法。
我们纳入了2019年至2023年间在我院连续诊断为PA并接受AVS的168例患者。将采用轻柔负压（GNP）采血对PA亚型诊断准确性的影响与重力采血（即血液自然流出）的影响进行比较。
使用这两种采血方法，139例患者双侧AVS均成功完成。在这139例患者中，两种采血方法的亚型诊断结果在128例（92.1%）中一致，在11例（7.9%）中不一致。在11例亚型诊断结果不一致的患者中，3例进行了单侧肾上腺切除术，其中1例重力采血诊断为右侧单侧亚型而GNP采血诊断为双侧亚型，1例重力采血诊断为双侧亚型而GNP采血诊断为右侧单侧亚型，1例重力采血诊断为左侧单侧亚型而GNP采血诊断为双侧亚型。手术后的病理结果显示，重力法获取的数据假阴性率为20%（1/5），GNP法获取的数据假阴性率为80%（4/5）。重力采血法进行双侧AVS的时间明显长于GNP采血法（p < 0.01）。
对于PA患者的AVS，重力法可能优于GNP法。
