Clinical Application Analysis Of Adrenal Venous Sampling In Patients With Hypertension Complicated With Adrenal Lesions

Research Objective:To comparison and analysis the diagnostic characteristics and differences of adrenal venous sampling technology(AVS)in primary aldosteronism(PA)and non-PA Patients,and compare and analyze blood pressure and other outcomes after surgical treatment under the guidance of AVS,in order to explore the application effect of AVS in different population.Research Methods:Retrospective analysis the clinical data of 65 Patients Screening for hypertension in the Department of Cardiovascular Medicine at The First Affiliated Hospital of Xiamen University from September 2018 to November 2020(mainly for the patients with hypertension combined adrenal lesions).The data including 60 cases of adrenal CT(Adrenal Computed Tomography)shows the adrenal lesions,CT described as hyperplasia,nodes and adenomas;there was no obvious abnormality on adrenal CT in 5 cases,which was suspected of adrenal associated hypertension.All Patients underwent AVS after the screening and diagnosis test for PA.According to the screening and diagnostic test results of PA,65 Patients were divided into PA group and non-PA group.In the PA group,screening and confirming test of PA were all positive,with a total of 17 Patients,9 of whom underwent surgical treatment;non-PA group:PA screening and or confirmatory test were negative in 48 cases,5 of which were operated.Research Result:The general indicators in PA group and non-PA group Patients such as age,sex,body mass index(Body Mass Index,BMI),course of disease,smoking and drinking history,hypertension and coronary heart disease family history,arteriosclerosis,diabetes,or abnormal glucose tolerance,hyperlipidemia,previous highest blood pressure,medication,previous highest blood pressure,medication,adrenal lesions side has no statistical significance difference.The laboratory indexes in two groups of Patients with total cholesterol,triglycerides,high-density lipoprotein cholesterol(HDL),low density lipoprotein cholesterol(LDL),24 hours urinary sodium content was no statistically significant difference.However,compare with those in non-PA group,the PA group has lower uric acid and serum potassium,has higher 24h urinary protein quantification and ARR ratio,with statistical significance.The degree of CT abnormality in the PA group(mean rank 45.18)was higher than that in the non-PA group(mean rank 28.69),and the difference was statistically significant.Unilateral dominant ratio of AVS in the PA group was(12/17),while that in the non-PA group was(32/48),the difference was not statistically significant.The coincidence rate between AVS and CT results was 64.7%in PA group and 58.3%in non-PA group,and the difference was not statistically significant.After adrenal resection guided by AVS,blood pressure and medication quantity in PA group and non-PA group were significantly lower than before surgery,and the serum potassium level was recovered compared with before surgery,with statistical significance.The postoperative improvement rate of subjective symptoms in the PA group was 66.7%,while that in the non-PA group was 60%.The difference was not statistically significant.However,the postoperative withdrawal rate of antihypertensive drugs in PA group(77.8%)was higher than that in non-PA group(0%),and the difference was statistically significant.Research Conclusion:The AVS in the PA and non-PA Patients have similar results,its guide surgery in two groups of patients were obtained clinical curative effect,but the PA group are more likely to be cured with surgery.AVS may be helpful in clinical decision-making for the treatment of hypertension with adrenal disease or suspected adrenal associated hypertension with surgical intention.