特发性醛固酮增多症的病理分型和手术预后

基础医学与临床 ›› 2021, Vol. 41 ›› Issue (10): 1481-1485.

特发性醛固酮增多症的病理分型和手术预后

王慧萍^1,2, 崔云英¹, 马晓森¹, 文进³, 任卫东², 童安莉^1*

中国医学科学院北京协和医学院北京协和医院 1.内分泌科,国家卫生健康委员会内分泌重点实验室; 3.泌尿外科,北京 100730;
2.河北北方学院研究生学院, 河北张家口 075000

收稿日期:2021-03-04 修回日期:2021-07-20 发布日期:2021-09-29
通讯作者: *tonganli@hotmail.com
基金资助:
国家自然科学基金(81770427,82070822);中国医学科学院医学与健康科技创新工程项目(2017-12M-1-001)

Pathological classification and surgical prognosis of idiopathic hyperaldosteronism

WANG Hui-ping^1,2, CUI Yun-ying¹, MA Xiao-sen¹, WEN Jin³, REN Wei-dong², TONG An-li^1*

1. Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission of China;3. Department of Urology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730;
2. Graduate School, Hebei North University, Zhangjiakou 075000, China

Received:2021-03-04 Revised:2021-07-20 Published:2021-09-29
Contact: *tonganli@hotmail.com

摘要/Abstract

摘要： 目的经手术治疗的特发性醛固酮增多症(简称特醛症)的病例较少,特醛症患者的肾上腺病理特征和手术预后的研究国内外报道甚少,本文回顾性分析23例特醛症患者的临床和病理特点以及手术预后情况,为提高临床诊治水平提供帮助。方法回顾性分析23例特醛症患者的临床特点,对特醛症患者的病理切片行HE染色及醛固酮合成酶的免疫组化染色,分析病理特点以及手术预后情况。结果 23例患者的病理分类均为非经典型。多发性醛固酮分泌结节12例,多发或单发醛固酮分泌微结节10例,1例为醛固酮分泌肾上腺皮质弥漫性增生并多发微结节。23例患者行单侧肾上腺手术切除,6例手术后血压和血钾正常(治愈率26%);17例术后血压下降但未恢复正常(缓解率74%)。与缓解组相比,治愈组患者术前血压更低。结论特醛症的肾上腺病理以多发性功能结节和微结节为主,特醛症患者手术切除单侧肾上腺能带来一定的临床获益。

关键词: 特发性醛固酮增多症, 病理分型, 手术预后

Abstract: Objective There are a few reports on surgical treatment of idiopathic hyperaldosteronism (IHA),pathological profile and prognosis. The clinical and pathological characteristics and prognosis of 23 patients with IHA were retrospectively analyzed in order to support potential improvement of diagnosis and treatment outcome. Methods Clinical characteristics of 23 patients with IHA were analyzed retrospectively. HE staining and CYP11B2 immunostaining were performed for pathological microsocopic observation. Pathological features and surgical prognosis were analyzed. Results All samples were categorized as nonclassic pathology, including 12 cases with multiple aldosterone-producing nodules,10 cases with multiple or single aldosterone-producing micronodules. Only one case had aldosterone-producing diffuse hyperplasia. Unilateral adrenal resection was performed in all patients. Postoperatively, blood pressure and serum potassium recovered to normal range in 6 patients with a cure rate 26%. Blood pressure decreased but did not return to normal in 17 patients (improve rate 74%). Compared with the improved group, patients in the cured group had a lower pre-operative blood pressure (P＜0.05). Conclusions Multiple functional nodules and micronodules are the main types in adrenal pathology of IHA. Unilateral adrenal resections probably bring clinical benefits in these patients.

Key words: idiopathic hyperaldosteronism, pathological classification, surgical prognosis

中图分类号:

R586.9

王慧萍, 崔云英, 马晓森, 文进, 任卫东, 童安莉. 特发性醛固酮增多症的病理分型和手术预后[J]. 基础医学与临床, 2021, 41(10): 1481-1485.

WANG Hui-ping, CUI Yun-ying, MA Xiao-sen, WEN Jin, REN Wei-dong, TONG An-li. Pathological classification and surgical prognosis of idiopathic hyperaldosteronism[J]. Basic & Clinical Medicine, 2021, 41(10): 1481-1485.

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