三维动态容积成像技术在肾上腺动脉栓塞术治疗原发性醛固酮增多症中的应用

Application of dynamic computed tomography in adrenal artery embolization for the treatment of primary aldosteronism

    摘要
  • 摘要:
    目的 初步探索三维动态容积成像技术（DynaCT）在肾上腺动脉栓塞术（SAAE）治疗原发性醛固酮增多症（PA）中应用的安全性和有效性。
    方法 入选行DynaCT辅助SAAE治疗的PA患者10例。术后随访血压、降压药使用、血钾、血钠、皮质醇和卧立位血浆醛固酮、血浆肾素、醛固酮/肾素比值（ARR）水平的变化以及不良事件的发生情况。
    结果 术后10例患者均参与随访。与术前相比，在术后1周，术后1、3个月立位醛固酮 中位数（P25，P75）：19.15（13.45，23.10），14.05（7.70，22.32），17.20（9.57，25.83）比38.70（30.42，48.68）ng/dL，均P＜0.05，卧位醛固酮 9.45（6.12，14.57），12.10（7.60，16.83），13.05（7.48，16.62）比25.95（21.30，34.57） ng/dL，均P＜0.05，降压药复合药物指数（CDI）（1.65 ± 0.67，1.34 ± 0.70，1.24 ± 0.58 比2.45 ± 0. 83，均P＜0.05）均下降；术后1、3个月24 h收缩压133.50（128.50，143.25），135.50（133.25，141.50）比152.50（143.50，161.50） mmHg，均P＜0.05下降，血钾（3.83±0.41），（3.81±0.48）比（3.33±0.30）mmol/L，P＜0.05升高；术后1个月24 h舒张压下降81.00（78.50，88.50）比92.50（85.75，99.50） mmHg，P＜0.05。术后血钠、血浆肾素活性、皮质醇、卧立位ARR与术前的差异无统计学差异（P＞0.05）。1例（1/10）患者完全治愈，术后停用降压药，醛固酮及血压维持正常。8例（8/10）术后血压及生化指标有不同程度改善。1例（1/10）无效。8例患者在未额外补钾的情况下，血钾可维持在正常范围内。
    结论 该研究初步显示DynaCT辅助SAAE治疗PA具有一定的可行性，但因样本量小，仍需进一步大样本对照研究验证。

     

    Abstract:
    Objective To preliminarily explore the safety and efficacy of dynamic computed tomography (DynaCT) in adrenal artery embolization (SAAE) for the treatment of primary aldosteronism (PA).
    Methods Ten PA patients with DynaCT-assisted SAAE were enrolled. Postoperative follow-up was conducted to observe the changes in blood pressure, antihypertensive medication use, serum potassium and sodium levels, cortisol, and plasma aldosterone concentration, plasma renin activity, aldosterone to rennin ratio (ARR) in the supine or upright position, as well as the occurrence of adverse events.
    Results All 10 patients were included in the follow-up. Compared with before the operation, upright aldosterone level median (P25, P75): 19.15 (13.45, 23.10), 14.05 (7.70, 22.32), 17.20 (9.57, 25.83) vs 38.70 (30.42, 48.68) ng/dL, all P＜0.05, supine aldosterone level 9.45 (6.12, 14.57), 12.10 (7.60, 16.83), 13.05 (7.48, 16.62) vs 25.95 (21.30, 34.57) ng/dL, all P＜0.05, the composite drug index (CDI) of antihypertensive medications (1.65 ± 0.67, 1.34 ± 0.70, 1.24 ± 0.58 vs 2.45 ± 0. 83, all P＜0.05) all decreased at 1 week, 1 month and 3 months after the operation; 24 h systolic blood pressure decreased 133.50 (128.50, 143.25), 135.50 (133.25, 141.50) vs 152.50 (143.50, 161.50) mmHg, all P＜0.05, and serum potassium level increased (3.83 ± 0.41), (3.81 ± 0.48) vs (3.33 ± 0.30) mmol/L, all P＜0.05 at 1 month and 3 months after the operation; and 24 h diastolic blood pressure decreased 81.00 (78.50, 88.50) vs 92.50 (85.75, 99.50) mmHg, P＜0.05 at 1 month after the operation. No statistically significant differences were observed between preoperative and postoperative levels of serum sodium, plasma renin activity, cortisol, and ARR (P ＞ 0.05). One case (1/10) was completely cured, with antihypertensive medications discontinued after the operation and aldosterone and blood pressure maintained at normal levels. Blood pressure and biochemical indicators improved to varying degrees in 8 cases (8/10) after the operation. One case (1/10) was invalid. The blood potassium levels of 8 patients could be maintained within the normal range without additional potassium supplementation.
    Conclusions This study initially indicates that DynaCT-assisted SAAE is feasible in the treatment of PA. However, due to the small sample size, further large-sample controlled studies are still needed.

     

    • HTML全文
    • 参考文献(19)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回