肾上腺薄层CT在筛查肾上腺性高血压中的应用价值

摘要

目的：评价肾上腺薄层CT扫描在初诊高血压(年龄<50岁，血压达高血压2级及以上)及既往确诊高血压(发病年龄<40岁)且目前已用3种降压药物联合治疗但血压控制仍不理想的患者中筛查肾上腺性高血压的应用价值。方法回顾性分析2013年2月至2014年10月蚌埠市第三人民医院门诊及住院的高血压患者共126例。上述患者均行双侧肾上腺薄层CT扫描、双侧肾上腺彩超、血电解质、肝肾功能检查，并对发现有肾上腺形态学异常的患者进一步行血、尿醛固酮( ALD )，血管紧张素Ⅰ(37℃和4℃)、肾素活性(PRA)、促肾上腺皮质激素(ACTH)、皮质醇(COR)、血浆肾上腺素(AD)、血浆去甲肾上腺素(NAD)、血浆多巴胺( DOP)、尿香草扁桃酸( VMA)检查。比较肾上腺薄层CT与超声检查的对肾上腺形态学异常的检出率。结果126例患者中共检出肾上腺性高血压23例，其中有19例于泌尿外科行手术治疗，术后病理诊断为肾上腺腺瘤者17例，嗜铬细胞瘤2例；结合内分泌激素水平测定诊断原发性醛固酮增多症者16例，皮质醇增多症5例，嗜铬细胞瘤2例。 CT检查出形态学异常者66例，阳性率52．4%，明确诊断21例，符合诊断率16．7%；彩超检查出形态学异常者42例，阳性率33．3%，明确诊断9例，符合诊断率7．1%。在筛查肾上腺性高血压中肾上腺薄层CT的检出率高于彩超检查(P<0．05)。结论与彩超检查相比，肾上腺薄层CT扫描在筛查肾上腺性高血压中简单高效，可以提高检出率，降低漏诊率。%Objective To discuss the value of adrenal thin-section CT scanning in identifying new patients with hypertension ( age<50 years old, with second level of hypertension or higher) and previously diagnosed patients treated with three hypertension drugs however whose treatment outcome was not ideal ( age<40 years old) . Methods The clinical data of 126 patients with hypertension treated in our hospital ( inpatients and outpatients) from February 2013 to October 2014 were analysed, and all the patients were examined with adrenal thin-section CT scan, bilateral adrenal ultrasound, serum electrolytes and liver and kidney function. All patients whose inspection result was abnormal would been further reviewed, in terms of blood and urine aldosterone (ALD), angiotensin Ι (37 ℃ and 4 ℃), renin activity ( PRA) , adrenocorticotropic hormone ( ACTH) , cortisol ( COR) , plasma adrenaline ( AD) , the plasma to noradrenaline ( NAD) , plasma dopamine ( DOP) and urinary VMA ( VMA) . The detection rate was compared in the examination of adrenal thin-section CT scan and ultra-sound. Results 23 out of 126 patients were diagnosed adrenal hypertension, 19 of whom were treated with urinary surgery. 17 out of 19 pa-tients were diagnosed with adrenal adenoma and the rest 2 with pheochromocytoma. 66 of 126 patients were found to have morphological ab-normalities (52. 4%). 21 were clearly diagnosed with a diagnostic rate of 16. 7%. 42 of 126 patients were found to have morphological ab-normalities with color Doppler ultrasound (33. 3%) and 9 were clearly diagnosed (7. 1%). The diagnostic rate of adrenal thin-section CT was higher than that of color Doppler ultrasound (P<0. 05). Conclusion Adrenal thin-section CT scan is convenient and efficient in iden-tifying adrenal hypertension, which may increase the diagnostic rate.