醛固酮腺瘤45例临床分析.docVIP

精品论文 参考文献 醛固酮腺瘤45例临床分析 吴海花1 汪志红2 　　（1.四川省成都大学附属医院内分泌科 610081；2.重庆医科大学附属第一医院 400016） 　　【摘要】目的：探讨醛固酮腺瘤(APA)诊断方法的价值。方法：回顾性分析术后病理确诊为APA的患者45例的一般临床资料、实验室检查、影像学检查及术后病理结果。结果：45例APA患者中血钾降低者30例。立位血清醛固酮/直接肾素浓度（ARR）＞24 和48(pg/ml)/ (?IU/ml)的例数分别为41例和36例，卧位ARR＞24和48(pg/ml)/ (?IU/ml)则分别有43例和39例。电子计算机断层扫描（CT）诊断与术后病理诊断的符合率为93.3%。结论： ARR在APA中的筛查效率较高，肾上腺薄层CT增强扫描是APA定位诊断的首选无创性检查。 　　【关键词】醛固酮腺瘤；血清醛固酮；直接肾素浓度；血清醛固酮/直接肾素浓度 　　【中图分类号】R586.9 【文献标志码】A 　　Clinical analysis of 45 cases of aldosterone-producing adenoma 　　Wu Haihua1, Wang Zhihong2(1.Department of Endocrinology, Affiliated Hospital of Chengdu University,Chengdu,Sichuan 610081,China;2.Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China) 　　【Abstract】Objective To evaluate the diagnostic validity of the methods in screening aldosterone producing adenoma(APA). Methods A retrospective analysis 45 cases of APA of the postoperative pathologic diagnosis with the clinical data, laboratory examination, imaging examination and pathological findings. Results Of all APA patients, 30 cases had hypokalemia. The erect position serum aldosterone /direct renin concentration ratio (ARR) ＞24 and 48(pg/ml)/ (?IU/ml) were 41 cases and 36 cases，The supine position ARR ＞24 and 48(pg/ml)/ (?IU/ml) were 43 cases and 39 cases. The coincidence rate of Computed tomography （CT）and postoperative pathological diagnosis was 93.3%. Conclusion ARR plays the important role in screening APA, and the CT enhanced scan is the main method of APA positioning diagnosis. 　　【Key words】aldosterone-producing adenoma；serum aldsterone；direct renin concentration；serum aldosterone/direct renin concentration ratio 原发性醛固酮增多症（primary aldosteronism，PA）简称原醛症, 是1955 年由Conn 首先发现并命名的一种内分泌性高血压。现有的大量资料显示，原醛症患病率在所有高血压患者中超过10%[1,2]。而醛固酮腺瘤(aldosterone-producing adenoma，APA)在原醛症中的比例占到了30%～43% [1]，且近年来的研究发现，与年龄、性别、血压水平相匹配的原发性高血压（primary hypertension，PH）患者相比, APA患者左室肥厚更严重、左室舒张功能降低更明显，心梗、心律失常、慢性肾脏病比例更高[3-5]，早期诊断及合理的治疗能够明显改善APA患