Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism.
Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism.
复制标题
DOI：
10.3803/enm.2021.1047
复制
发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Kim SW
中科院分区：
文献类型：
--
作者：
Yang YS;Lee SH;Kim JH;Yoo JH;Lee JH;Lee SY;Hong AR;Lee DH;Koh JM;Kim JH;Kim SW
肾上腺静脉采血(AVS)用于区分原发性醛固酮增多症(PA)的亚型。对侧抑制(CS；aldosterone/cortisolnondominant<；aldosterone/cortisolperipheral))在房室传导阻滞中的临床意义尚不清楚。本研究旨在探讨单侧肾上腺切除术后CS的临床意义及其对术后预后的影响。在这项多中心的回顾性观察研究中，我们分析了成功接受促肾上腺皮质激素刺激的动静脉曲张和单侧肾上腺切除术的PA患者。插管成功定义为选择性指数(皮质肾上腺/外周皮质)≥3。根据国际一级醛固酮增多症手术结局共识评估单侧肾上腺切除术后的临床和生化结果。在分析的263例患者中，247例(93.9%)患有CS。与非CS患者相比，CS患者血钾水平降低，血浆醛固酮浓度升高，醛固酮/肾素比值(ARR)升高，腺瘤体积增大。有CS的偏侧指数显著高于无CS的偏侧指数(P<；0.001)。尽管CS患者术后血压和ARR显著降低，但两组的临床和生化结果是相似的。当用受试者工作特征分析确定年龄的分界值时，在调整其他因素后，对侧抑制指数(≥)为0.26的50岁≤患者发生慢性肾脏疾病的优势比(OR值为6.43；95%可信区间为1.3~31.69)。CS可能不能预测单侧醛固酮过剩患者的术后临床和生化结果，但在CSI0.26岁以上的患者中，CS与术后肾功能恶化有关。
Adrenal venous sampling (AVS) is performed to distinguish the subtype of primary aldosteronism (PA). The clinical implication of contralateral suppression (CS; aldosterone/cortisolnondominant<aldosterone/cortisolperipheral) at AVS remains unclear. We aimed to investigate the clinical significance of CS and its impact on postoperative outcomes after unilateral adrenalectomy. In this retrospective observational multi-center study, we analyzed PA patients who underwent both successful adrenocorticotropin hormone-stimulated AVS and unilateral adrenalectomy. Successful cannulation was defined as the selectivity index (cortisoladrenal/cortisolperipheral) ≥3. Clinical and biochemical outcomes after unilateral adrenalectomy were evaluated based on the international Primary Aldosteronism Surgical Outcome consensus. Among 263 patients analyzed, 247 had CS (93.9%). Patients with CS had lower serum potassium levels, higher plasma aldosterone concentration, higher aldosterone-to-renin ratio (ARR), and larger adenoma size than those without CS. Those with CS showed significantly higher lateralization index than those without CS (P<0.001). Although postoperative blood pressure and ARR significantly decreased in those with CS, clinical and biochemical outcomes were comparable in both groups. When the cut-off value of age was determined using receiver operating characteristic (ROC) analysis, patients aged ≥50 years old with contralateral suppression index (CSI; the ratio between aldosterone/cortisolnondominant and aldosterone/cortisolperipheral) ≤0.26 had greater odds ratio (6.43; 95% confidence interval, 1.30 to 31.69) of incident chronic kidney disease than those aged <50 years with CSI >0.26 after adjusting for other factors. CS may not predict postoperative clinical and biochemical outcomes in subjects with unilateral aldosterone excess, but it is associated with postsurgical deterioration of renal function in subjects over 50 years with CSI ≤0.26.