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目的评价原发性醛固酮增多症(PA)诊断中多项临床试验方法的作用。方法收集1995～2000年上海第二医科大学附属瑞金医院104例PA患者的临床资料,统计分析生化检查、体位激发试验、影像学检查与肾上腺静脉插管在诊断中的阳性率及符合率。结果(1)血醛固酮升高为筛选PA阳性率最高的检测指标。(2)醛固酮腺瘤患者生化异常较明显。(3)与手术病理比较,B超在醛固酮腺瘤和双侧肾上腺增生中的诊断符合率分为95.77%及73.33%;CT为98.51%及31.03%;体位激发试验以升幅30%为标准时在醛固酮腺瘤和双侧肾上腺增生中的符合率分别为61.11%及57.14%,以50%为标准时为72.22%及42.86%;肾上腺静脉插管的符合率为83.33%及100%。结论PA的诊断中,典型患者经血钾、血尿醛固酮及血浆肾素活性等筛查可明确诊断,但部分患者上述生化改变并不典型。体位激发试验结果在醛固酮腺瘤及双侧肾上腺增生中有部分重叠。影像学未能发现明显占位灶者可行肾上腺静脉插管检查。
Objective To evaluate the role of multiple clinical trials in the diagnosis of primary aldosteronism (PA). Methods The clinical data of 104 PA patients in Ruijin Hospital Affiliated to Shanghai Second Medical University from 1995 to 2000 were collected. The biochemical tests, body position stimulation test, imaging examination and adrenal vein cannulation were used in the diagnosis of PA patients. Results (1) The increase of serum aldosterone was the highest detection index of screening PA positive rate. (2) The biochemical abnormality of aldosterone adenoma patients is more obvious. (3) Compared with the surgical pathology, the diagnostic coincidence rates of B-ultrasound in aldosterone adenoma and bilateral adrenal hyperplasia were 95.77% and 73.33%, CT was 98.51% and 31.03%, respectively. The body position test was 30% The coincidence rates of aldosterone adenoma and bilateral adrenal hyperplasia were 61.11% and 57.14% respectively, with the rates of 72.22% and 42.86% with 50% as standard. The coincidence rates of adrenal vein cannulation were 83.33% and 100% respectively. Conclusion In the diagnosis of PA, typical patients with serum potassium, urinary aldosterone and plasma renin activity screening can confirm the diagnosis, but in some patients the above biochemical changes are not typical. Postural stimulation test results partially overlap in aldosterone adenoma and bilateral adrenal hyperplasia. Imaging studies failed to find significant occupying lesions feasible adrenal vein catheterization.