Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism.
Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism.
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DOI：
10.1210/js.2018-00055
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发表时间：
2018-08-01
影响因子：
4.1
通讯作者：
Naruse M
中科院分区：
文献类型：
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作者：
Umakoshi H;Tsuiki M;Yokomoto-Umakoshi M;Takeda Y;Takashi Y;Kurihara I;Itoh H;Katabami T;Ichijo T;Wada N;Shibayama Y;Yoshimoto T;Ashida K;Ogawa Y;Kawashima J;Sone M;Inagaki N;Takahashi K;Watanabe M;Matsuda Y;Kobayashi H;Shibata H;Kamemura K;Otsuki M;Fujii Y;Yamamto K;Ogo A;Okamura S;Miyauchi S;Fukuoka T;Izawa S;Yanase T;Hashimoto S;Yamada M;Yoshikawa Y;Kai T;Suzuki T;Kawamura T;Naruse M
本研究的目的是调查肾上腺静脉采样(AVS)的定侧截断值对手术结果的影响。应用促肾上腺皮质激素刺激的血管紧张素转换酶系统指导377例原发性醛固酮增多症(PA)患者的手术治疗，术后6个月进行评估。根据AVS醛固酮偏侧化指数(LI)，确定临床受益和生化完全成功的患者的比例。安莉2~4岁组47例，临床受益29例；安莉组4~10岁组66例，临床受益66例；安莉组203例，临床受益158例(趋势P<；0.01)。安莉2~4岁组27例，安莉4~10岁组60例，安莉+10岁组127例(趋势P=0.024)。调整混杂因素后，以安莉在2~4岁之间的患者为参考，临床获益仅与安莉和GT；10(OR，2.3；95%CI，1.03~5.16)有关，而完全生化成功与安莉在4~10之间(OR，2.83；95%CI，1.14~7.01)或Li>；10(OR，3.55；95%CI，1.47~8.55)相关。使用严格的LI诊断阈值时，临床结果差异较小；使用安莉>；4时，生化治愈效果较好。我们的研究通过标准化结果测量验证了安莉和GT；4可能适合于确定PA的单侧疾病。我们通过标准化的方法研究了动静脉动静脉畸形的定侧界限对手术结果的影响，并验证了安莉和GT；4对于确定PA的单侧病变是合适的。
The aim of this study was to investigate the impact of adrenal venous sampling (AVS) lateralization cutoffs on surgical outcomes. Cosyntropin-stimulated AVS was used to guide surgical management of 377 patients with primary aldosteronism (PA) who were evaluated 6 months after surgery. The proportion of patients that achieved clinical benefit and complete biochemical success based on the AVS aldosterone lateralization index (LI) was determined. Clinical benefit was achieved in 29 of 47 patients with an LI between 2 and 4, in 66 of 101 with an LI between 4 and 10, and in 158 of 203 with an LI > 10 (P < 0.01 for trend). Complete biochemical success was achieved in 27 of 42 with an LI between 2 and 4, in 60 of 76 with an LI between 4 and 10, and in 127 of 155 with an LI > 10 (P = 0.024 for trend). After adjustment for confounders and using those patients with an LI between 2 and 4 as a reference, a clinical benefit was associated only with those with an LI > 10 (OR, 2.30; 95% CI, 1.03 to 5.16), whereas complete biochemical success was associated with those with an LI between 4 and 10 (OR, 2.83; 95% CI, 1.14 to 7.01) or LI > 10 (OR, 3.55; 95% CI, 1.47 to 8.55). Difference of clinical outcome was relatively small when strict LI diagnostic threshold was used; biochemical cure was sufficiently achieved when an LI > 4 was used. Our study by standardized outcome measures validated that an LI > 4 may be appropriate for determining unilateral disease in PA. We investigated the impact of AVS lateralization cutoffs on surgical outcome by standardized measures and validated that an LI > 4 is appropriate to determine unilateral disease in PA.