Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates
Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates
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DOI：
10.1530/eje-11-0287
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发表时间：
2011-08-01
影响因子：
5.8
通讯作者：
Reincke, Martin
中科院分区：
文献类型：
--
作者：
Betz, Matthias J.;Degenhart, Christoph;Reincke, Martin
目的：肾上腺静脉采样（AVS）被认为是原发性醛固酮增多症（PA）鉴别诊断的金标准，但不同中心的成功率有所不同。我们假设，快速（术中）皮质醇测量可以提高性能，在一个中心，最初低AVSsuccessrate.Design：我们分析了46例确诊PA研究2008年和2010年之间。2004年至2008年间，通过回顾性病历审查确定的47例PA患者作为对照。所有患者均在一家三级护理大学医院接受治疗。方法：从2008年开始，在所有患者中进行快速皮质醇测定（RCA）在AVS程序。肾上腺静脉和股静脉样本之间的皮质醇梯度>= 2.0被用作成功标准。如果肾上腺静脉皮质醇低于此阈值，最多两次重复采样，结果：在控制期间，47例AVS中有26例成功（55%）。在引入RCA后，46例AVS中有39例（85%）成功（P=0.003）。在46例病例中，21例（46%）需要重新手术。总体成功率的增加是由于成功的右侧AVS的增加（85% vs 62%，在引入RCA之前; P=0.02）和培训效果（P=0.024的趋势）。结论：在最初AVS成功率较低的中心，AVS期间的RCA是有用的。
Objective: Adrenal vein sampling (AVS) is considered the gold standard in the differential diagnosis of primary aldosteronism (PA), but success rates vary between centers. We hypothesized that rapid (intraprocedure) cortisol measurement can improve performance in a center with initially low AVS success rate.Design: We analyzed 46 patients with confirmed PA studied between 2008 and 2010. Forty-seven PA patients studied between 2004 and 2008 identified by retrospective chart review served as controls. All patients were treated at a single tertiary care university hospital. Methods: Starting in 2008, rapid cortisol assays (RCA) were performed in all patients during the AVS procedure. A cortisol gradient of >= 2.0 between adrenal vein and a femoral vein sample was used as success criterion. Up to two repeat samples were drawn if adrenal vein cortisol was below this threshold.Results: During the control period 26 of 47 AVS were successful (55%). After introduction of RCA, 39 out of 46 AVS (85%) were successful (P=0.003). In 21 of the 46 cases (46%) a resampling was necessary. The increase in overall success was due to an increase in successful right AVS (85 vs 62% before introduction of RCA; P=0.02) and a training effect (P=0.024 for trend).Conclusion: RCA during AVS are useful in centers with an initially low AVS success rate.