多焦点的,不对称的双边初级阿尔多斯特罗尼斯不能被强大的上腺静脉采样排斥侧面化:国际回顾性队列研究
Adina F Turcu1, Yuta Tezuka2, Jung Soo Lim3
1Division of Metabolism, Endocrinology, and Diabetes (A.F.T., Z.S., H.L.), University of Michigan, Ann Arbor.
Hypertension (Dallas, Tex. : 1979)
|January 4, 2024
概括
16%的患有原发性阿尔多斯特隆症 (PA) 的患者在上腺静脉采样 (AVS) 引导的上腺切除术后经历了残留的PA. 多焦点性疾病和特定的基因突变预测不完全治愈,需要长期监测有效的PA管理.
科学领域:
- 内分泌学 在内分泌学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 手术瘤学手术瘤学
背景情况:
- 原发性阿尔多斯顿主义 (PA) 通常被分为单边或双边.
- 上腺静脉采样 (AVS) 具有侧面化指数 (LI) ≥2至4指导单侧上腺切除术,以推定单侧PA.
- 这项研究调查了AVS导向上腺切除术后的结果.
研究的目的:
- 为了评估上腺静脉采样 (AVS) 引导的单侧上腺切除术后残留初级上腺症 (PA) 的发生率和特征.
- 为了确定术后持久性PA的预测因素.
主要方法:
- 国际回顾性队列研究包括283名来自7个中心的PA患者,这些患者接受了基于LI≥4.4的单边上腺切除术.
- 对阿尔多氨酸合成酶 (CYP11B2) 免疫组织化学和下一代对上腺组织的测序的分析.
- 手术后的随访时间平均为326天.
主要成果:
- 16%的患者 (n=45) 在上腺切除术后有残留PA.
- 残留PA与多焦点CYP11B2阳性区域 (73%对23%) 和*CACNA1D*突变 (63%对33%) 相关.
- 剩余PA的预测因素包括黑人种族,在基线时只有AVS横向化,以及CT-AVS不一致.
结论:
- 多焦点,不对称的双边PA是常见的,可以被AVS遗漏.
- 长期的术后监测对于识别残留PA至关重要.
- 针对性药物治疗的及时启动对于持久性PA患者至关重要.
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