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在上腺静脉采样中对患有初级阿尔多斯特的患者进行皮质otropin刺激:ADOPA随机临床试验
Shumin Yang1, Zhipeng Du1, Xizi Zhang1
1Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
JAMA network open
|October 23, 2023
概括
上腺静脉采样 (AVS) 随着或没有皮质激素 (ACTH) 刺激,在原发性阿尔多斯特主义 (PA) 的生物化学或临床缓解率上没有显著差异. 这表明ACTH刺激可能不会在PA管理中提供额外的临床益处.
科学领域:
- 内分泌学 在内分泌学.
- 腎臟病學 (nephrology) 是一種醫學.
- 手术瘤学手术瘤学
背景情况:
- 主要阿尔多斯特主义 (PA) 诊断通常依赖于上腺静脉采样 (AVS) 来区分单边和双边形式.
- 在AVS期间对皮质激素 (ACTH) 刺激的必要性,以指导PA的治疗决策仍然不确定.
- 基于有或没有ACTH刺激的AVS的临床结果需要进一步调查.
研究的目的:
- 在PA患者中,以ACTH刺激与非ACTH刺激的AVS为指导的治疗决策的有效性进行比较.
- 评估两种AVS协议之间的生化和临床缓解率的差异.
主要方法:
- 进行了一项随机临床试验 (RCT),涉及228名18至70岁的PA患者.
- 参与者被随机分配,接受ACTH刺激或非ACTH刺激的AVS.
- 随访时间为12个月,评估完整的生化和临床缓解,抗高血压剂量,AVS成功和不良事件.
主要成果:
- 在ACTH刺激 (49.6%) 和非ACTH刺激 (51.3%) 组之间的完全生化缓解率没有显著差异 (P=.79).
- 完全临床缓解率在两组之间也没有显著差异 (22.6%对27.4%,P=.40).
- 抗高血压药物治疗强度,AVS成功率和不良事件发生率在两组之间都是可比的.
结论:
- 基于AVS与或没有ACTH刺激的PA的治疗决定产生了类似的临床结果.
- 在AVS期间的ACTH刺激可能不会为PA患者提供额外的临床益处.
- 研究结果表明,当前没有ACTH刺激的AVS协议足以指导PA治疗,特别是在研究的人群中.
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