现代泌尿外科杂志
現代泌尿外科雜誌
현대비뇨외과잡지
JOURNAL OF MODERN UROLOGY
2014年
11期
728-731
,共4页
赵振华%胡卫列%郑东升%赵国平%陈仕杰%陈虎%李岱%赖建生
趙振華%鬍衛列%鄭東升%趙國平%陳仕傑%陳虎%李岱%賴建生
조진화%호위렬%정동승%조국평%진사걸%진호%리대%뢰건생
单侧肾上腺切除%肾上腺皮质功能%原发性醛固酮增多症
單側腎上腺切除%腎上腺皮質功能%原髮性醛固酮增多癥
단측신상선절제%신상선피질공능%원발성철고동증다증
unilateral adrenalectomy%adrenal cortisol function%primary aldosteronism
目的:对比分析原发性醛固酮增多症(PHA)患者单侧肾上腺切除前后肾上腺皮质分泌功能变化,评估分析单侧肾上腺切除后对侧肾上腺皮质储备功能。方法选取2006年1月至2013年2月接受单侧肾上腺切除手术的42例患者的临床资料。对患者手术前后早晨空腹血皮质醇、促肾上腺皮质素(ACT H )水平、以及促肾上腺皮质激素兴奋1 mg地塞米松抑制试验结果进行了有效的统计学分析。结果42例患者均无出现肾上腺皮质功能不全。手术前后基础皮质醇水平无明显差异。然而,单侧肾上腺切除术后基础ACT H水平明显提高。促肾上腺皮质激素兴奋1 mg地塞米松抑制试验的皮质醇峰值水平明显下降。术后皮质醇峰值水平约为术前82.7%(76.0%~91.4%)。结论不伴有皮质醇增多症或亚临床型皮质醇增多症的P H A患者行单侧肾上腺切除,术后血皮质醇水平可维持在正常范围之内,但肾上腺皮质储备功能出现不同程度的下降,其储备功能不低于术前80%,足以使患者术后不会出现肾上腺皮质功能不全。
目的:對比分析原髮性醛固酮增多癥(PHA)患者單側腎上腺切除前後腎上腺皮質分泌功能變化,評估分析單側腎上腺切除後對側腎上腺皮質儲備功能。方法選取2006年1月至2013年2月接受單側腎上腺切除手術的42例患者的臨床資料。對患者手術前後早晨空腹血皮質醇、促腎上腺皮質素(ACT H )水平、以及促腎上腺皮質激素興奮1 mg地塞米鬆抑製試驗結果進行瞭有效的統計學分析。結果42例患者均無齣現腎上腺皮質功能不全。手術前後基礎皮質醇水平無明顯差異。然而,單側腎上腺切除術後基礎ACT H水平明顯提高。促腎上腺皮質激素興奮1 mg地塞米鬆抑製試驗的皮質醇峰值水平明顯下降。術後皮質醇峰值水平約為術前82.7%(76.0%~91.4%)。結論不伴有皮質醇增多癥或亞臨床型皮質醇增多癥的P H A患者行單側腎上腺切除,術後血皮質醇水平可維持在正常範圍之內,但腎上腺皮質儲備功能齣現不同程度的下降,其儲備功能不低于術前80%,足以使患者術後不會齣現腎上腺皮質功能不全。
목적:대비분석원발성철고동증다증(PHA)환자단측신상선절제전후신상선피질분비공능변화,평고분석단측신상선절제후대측신상선피질저비공능。방법선취2006년1월지2013년2월접수단측신상선절제수술적42례환자적림상자료。대환자수술전후조신공복혈피질순、촉신상선피질소(ACT H )수평、이급촉신상선피질격소흥강1 mg지새미송억제시험결과진행료유효적통계학분석。결과42례환자균무출현신상선피질공능불전。수술전후기출피질순수평무명현차이。연이,단측신상선절제술후기출ACT H수평명현제고。촉신상선피질격소흥강1 mg지새미송억제시험적피질순봉치수평명현하강。술후피질순봉치수평약위술전82.7%(76.0%~91.4%)。결론불반유피질순증다증혹아림상형피질순증다증적P H A환자행단측신상선절제,술후혈피질순수평가유지재정상범위지내,단신상선피질저비공능출현불동정도적하강,기저비공능불저우술전80%,족이사환자술후불회출현신상선피질공능불전。
ABSTRACT:Objective After unilateral adrenalectomy (uADX ) in patients with primary aldosteronism , the remaining contralateral adrenal gland is generally considered sufficient to support life .However ,few studies have compared adrenal re‐serve function before and after uADX .Therefore ,we closely evaluated adrenal cortisol secretory function before and after uADX in patients with primary aldosteronism .Methods From Jan .2006 to Feb .2013 ,a total of 42 patients who were diag‐nosed with primary aldosteronism and underwent uADX were initially included in this study .Patients with subclinical Cushing's syndrome (SCS) or Cushing's syndrome were excluded on suspicion of autonomous cortisol secretion .All 42 patients were final‐ly evaluated .Morning basal serum cortisol and plasma adrenocorticotropin hormone (ACTH) levels were measured ,and ACTH stimulation tests under 1‐mg dexamethasone suppression (dex‐ACTH test) were performed before and after uADX .Results No patient developed clinical adrenal insufficiency . Basal cortisol levels were not significantly different before and after uADX .However ,basal ACTH levels were significantly elevated after uADX .In addition ,peak cortisol levels on the dex‐ACTH test decreased in all patients after uADX .The peak cortisol level after uADX was 82 .7 (76 .0-91 .4)% of the level be‐fore uADX .Conclusions The adrenal cortisol reserve function is mildly reduced after uADX in patients without SCS or Cushing's syndrome ,although their basal cortisol level is sustained by elevated ACTH .Nevertheless ,more than 80% of the re‐serve capacity is preserved after uADX ,which is compatible with the fact that patients generally exhibit no problems in daily life after uADX .