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60岁及以上肾上腺皮质腺瘤患者临床特点分析

Clinical diagnosis and treatment of adrenocortical adenoma in patients aged 60 years or above

摘要:

目的 探讨≥60岁肾上腺皮质腺瘤患者的临床特点.方法 回顾性分析2004年1月至2014年1月北京协和医院泌尿外科收治的249例年龄≥60岁的肾上腺皮质腺瘤患者的临床资料,并且与同期随机抽取的249例30 ~50岁的肾上腺皮质腺瘤患者进行比较,分析其临床特点、治疗及预后情况.两组研究数据的比较采用t检验或x2检验.结果 249例≥60岁患者均接受内分泌功能检查,术前诊断为无功能性腺瘤144例,醛固酮腺瘤94例,库欣腺瘤11例.≥60岁患者中,26.4%(38/144)的患者术前诊断为无功能性腺瘤合并冠心病或脑卒中,低于醛固酮腺瘤及库欣腺瘤患者的54.3% (57/105) (x2 =20.027 ,P =0.000).≥60岁术前合并低钾血症的患者术后有91.5% (65/71)低血钾状况得到缓解.≥60岁无功能性腺瘤患者中49.1% (53/108)的术后血压控制情况改善,有功能腺瘤患者中64.0%(48/75)的术后血压控制情况改善,差异有统计学意义(x2=3.987,P=0.046).≥60岁组患者79例(31.7%)空腹血糖升高(≥7.1 mmol/L),30 ~50岁组患者35例(14.1%)空腹血糖升高,两组比较差异有统计学意义(x2=22.02,P=0.000).≥60岁组与30~50岁组中诊断为醛固酮腺瘤的患者比较,血清钾离子浓度、血浆醛固酮水平差异均有统计学意义(t=10.48、-2.58,P =0.00、0.01).结论 ≥60岁肾上腺腺瘤患者以无功能性腺瘤为主,其中醛固酮腺瘤患者腺瘤皮质激素分泌水平及低血钾程度较30 ~50岁患者低,但合并心脑血管损害比例较高.小部分无功能性腺瘤合并高血压病的患者可从手术治疗中获益.

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abstracts:

Objective To investigate the clinical features of adrenocortical adenoma's diagnosis and treatment in patients aged 60 years or above.Methods A retrospective study was performed with a total of 249 patients aged 60 years or above who suffered from adrenocortical adenoma and treated in Peking Union Medical College Hospital from January 2004 to January 2014.The clinical features, treatments and prognosis of the 249 patients aged 60 years or above were compared with another 249 patients which were randomly selected during the same period aged from 30 to 50 years.t-test or x2 test was used to analyze the data between the two groups.Results Endocrine examinations were performed in all 249 patients aged 60 years or above.There were 144 patients diagnosed as non-functional adrenocortical adenoma, 94 cases as aldosterone-producing adenoma and 11 cases as Cushing adenoma.For the patients aged 60 years or above, the rate of cardio-cerebral vascular incident in non-functional adrenocortical adenoma group was 26.4% (38/144),which was significantly lower than that of the aldosterone-producing adenoma and Cushing adenoma group(54.3% ,57/105) (x2 =20.027, P =0.000).There were 91.5% (65/71) of the patients aged 60 years or above who got a relief in low blood potassium symptoms after the operation.Forty-nine point one percent(53/108) of the non-functional adrenocortical adenoma patients aged 60 years or above had a better control of their blood pressure level, while functional adrenocortical adenoma group were 64.0% (48/75) which indicated that the functional adrenocortical adenoma patients have a better control of their blood pressure then the non-functional adrenocortical adenoma patients after the operation (x2 =3.987, P =0.046).There were 37.1% of the patients aged 60 years or above whose fasting blood-glucose was higher than 7.1 mmol/L, while the patients aged from 30 to 50 years was 14.1% (x2 =22.02, P =0.000).The differences in plasma aldosterone and blood potassium between the patients aged 60 years or above and the patients aged from 30 to 50 years had statistical significance (t =10.48,-2.58;P =0.00, 0.01).Conclusions Most of the adrenocortical adenoma in patients aged 60 years or above is non-functional adrenocortical adenoma.Among who, patients with aldosterone-producing adenoma tend to have lower plasma aldosterone concentration and higher blood potassium level then the patients aged from 30 to 50 years.The patients aged 60 years or above with functional adrenocortical adenoma are tend to have severe cardiocerebral vascular incidence.A few of non-functional adrenocortical adenoma patients who combine with hypertension can benefit for the operation.

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