【摘要】：目的探討原發(fā)性醛固酮增多癥患者術后血壓轉歸的預測因素并建立Fisher判別模型以在術前預測血壓轉歸。方法收集2010年01月至2015年09月于重慶醫(yī)科大學附屬第一醫(yī)院手術切除單側病變或單側腎上腺的原發(fā)性醛固酮增多癥83例,根據(jù)術后血壓是否恢復正常分為治愈組和未愈組。比較兩組患者的人口學特征、高血壓情況、血尿生化和影像學特征,對有顯著差異的變量進行Fisher逐步判別,建立判別模型,并利用受試者工作特征曲線(ROC)與傳統(tǒng)的醛固酮瘤緩解評分(Aldosteronoma Resolution Score,ARS)、列線圖模型進行比較。結果1)治愈組52例(62.65%),未愈組31例(37.35%)。2)與治愈組相比,未愈組年齡、體重指數(shù)(BMI)更大,術前高血壓病程更長,使用的降壓藥物種數(shù)更多,血清甘油三酯(TG)、糖尿病患病率、吸煙率和飲酒率更高,而估計腎小球濾過率(eGFR)及HDL-C較治愈組顯著為低,CT表現(xiàn)為典型結節(jié)的更少(P0.05)。3)以BMI、高血壓藥物種數(shù)、典型CT結節(jié)、eGFR、TG建立Fisher判別模型,ROC曲線下面積及95%可信區(qū)間(CI)為0.857(0.764-0.951),最佳切點值0.1959時,判別治愈的敏感度和特異性分別為86.5%、83.9%。4)Fisher判別分析模型的曲線下面積高于ARS和列線圖模型,兩者分別為0.733(0.619-0.847)、0.735(0.619-0.851)。結論Fisher判別模型可以較準確地在術前預測原發(fā)性醛固酮增多癥術后血壓轉歸,有較好的臨床應用價值。
[Abstract]:Objective to investigate the predictors of postoperative blood pressure outcome in patients with primary aldosteronism and to establish Fisher discriminant model to predict blood pressure outcome before operation. Methods 83 cases of primary aldosteronism with unilateral lesion or unilateral adrenal gland resected in the first affiliated Hospital of Chongqing Medical University from January 2010 to September 2015 were divided into cured group and uncured group according to whether the blood pressure returned to normal after operation. The demographic characteristics, hypertension, hematuria biochemical and imaging features of the two groups were compared, and the variables with significant differences were identified by Fisher step by step, and the discriminant model was established. The working characteristic curve (ROC) of the subjects was compared with the traditional aldosterone tumor remission score (Aldosteronoma Resolution Score,ARS) and the line diagram model was compared. Results 1) there were 52 cases (62.65%) in the cured group and 31 cases (37.35%) in the uncured group. 2) compared with the cured group, the age, body mass index (BMI), duration of hypertension and the number of antihypertensive drugs used in the uncured group were longer, and the number of antihypertensive drugs in the uncured group was higher than that in the cured group. The prevalence of serum TG (TG), diabetes mellitus, smoking rate and drinking rate were higher, but the estimated glomerular filtration rate (eGFR) and HDL-C were significantly lower than those in the cured group, and the number of typical nodules on CT was less (P 0.05). 3) BMI, was the most common type of diabetes mellitus. 3) the estimated glomerular filtration rate was significantly lower than that in the cured group (P 0.05). The number of hypertension drugs, typical CT nodules and Fisher discriminant model were established by eGFR,TG. The area under ROC curve and 95% confidence interval (CI) were 0.857 (0.764 鈮，

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