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评估上腺静脉采样的侧面化指数,用于初级阿尔多斯特罗尼斯的手术指示
Hiroki Kobayashi1, Yoshihiro Nakamura1, Masanori Abe1
1Division of Nephrology, Hypertension, and Endocrinology, Nihon University School of Medicine, Tokyo 173-8610, Japan.
The Journal of clinical endocrinology and metabolism
|May 15, 2024
概括
上腺静脉采样 (AVS) 的新侧面化指数 (LI) 切断改善了原发性阿尔多斯特隆症 (PA) 的手术治愈预测. 将LI与成像结合起来,可以确定可能从上腺切除术中受益的患者.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 医学诊断 医学诊断 医学诊断
背景情况:
- 临床实践指南建议使用横向化指数 (LI) 来确定初级阿尔多斯特隆症 (PA) 手术的适用性.
- 准确的LI切断值对于识别可接受手术治疗的患者至关重要.
研究的目的:
- 在上腺静脉采样 (AVS) 中确定最佳的LI切断点,以诊断可以通过手术治愈的PA.
- 确定与患者对手术治愈率的期望一致的LI值.
主要方法:
- 对1550名接受AVS (有/没有ACTH刺激) 的PA患者进行了回顾性国际队列研究.
- 通过对82名PA患者进行的调查,关于上腺切除术预期治愈率的最佳切断线.
- 分析LI,对侧抑制和上腺结节检测,以预测手术治愈能力.
主要成果:
- 预计中位数80%的治愈率激励患者进行上腺切除术.
- 80%正预测值 (PPV) 的最佳LI截止值为3.8 (无刺激) 和3.4 (ACTH刺激).
- 逆侧面比率<0.4和CT上的上腺节独立预测可治愈的PA,当与LI结合时,PPV增加到96.6% (无刺激) 和89.6% (ACTH刺激).
结论:
- 在PA中AVS的最佳LI切割值对于非刺激和ACTH刺激的协议都得到了澄清.
- 在CT上对侧面抑制和上腺节块提供了宝贵的信息,超出LI在PA的手术指示.
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