原发性醛固酮增多症患者手术治疗中醛固酮合酶（CYP11B2）染色模式的分类系统建议及临床和生化相关性研究

Staining patterns of aldosterone synthase in patients undergoing surgery for primary aldosteronism: Proposal for system of categorization and investigation of clinical and biochemical correlation

SURGERY

影响因子:2.7

分区:医学2区 / 外科2区

发表日期:2025 Jan

作者: William MacDonald, Thomas J Giordano, Joshua Leisring, Anil Parwani, Priya H Dedhia, John Phay, Lawrence S Kirschner, Barbra S Miller

DOI: 10.1016/j.surg.2024.06.068

摘要

醛固酮合酶（CYP11B2）染色模式如何影响单侧原发性醛固酮增多症患者的预后尚未充分描述。我们假设建立分类系统将有助于未来的研究，并且单侧肾上腺切除术后不同的CYP11B2染色模式会影响临床和生化结果。回顾性分析2015年1月至2023年9月接受肾上腺切除治疗的原发性醛固酮增多症患者，收集患者的基本信息、临床资料及病理数据。制定了染色模式的分类系统，并将临床及生化结果与染色模式进行比较，以评估差异和相关性。采用SPSS软件进行描述性和统计分析。共纳入43例患者。发现的CYP11B2染色模式包括：(1) 单一腺瘤；(2)醛固酮产生结节或微结节；(3)第一型与第二型结合；(4)增生；(5)醛固酮产生性肾上腺皮质癌。在43例中，23例仅在单一腺瘤中观察到CYP11B2染色。3/23的染色涉及腺瘤的一部分。9岁以下患者中，4/9在非腺瘤组织中也出现CYP11B2染色。完全生化治愈率为86%，临床完全治愈率为23.2%。染色模式与性别、种族或年龄无显著相关性。染色模式未与早期临床或生化结果相关。原发性醛固酮增多症治疗患者的肾上腺切除样本显示多种CYP11B2染色模式，包括许多患者非腺瘤组织中也存在染色。该染色模式对临床预后的影响仍需进一步研究。统一的染色模式分类有助于不同研究间的一致报告和比较。

Abstract

How aldosterone synthase (CYP11B2) staining patterns impact patient outcomes in those with unilateral primary aldosteronism is not well described. We hypothesized that a system of categorization would benefit future research and that clinical and biochemical outcomes after unilateral adrenalectomy are impacted by different CYP11B2 staining patterns.A retrospective review of patients undergoing adrenalectomy for primary aldosteronism from January 2015 to September 2023 was conducted. Demographics, clinical, and pathologic data were analyzed. A system of categorization of staining patterns was developed. Clinical and biochemical outcomes were compared with staining patterns to assess differences and determine correlation. Descriptive and statistical analyses were performed using SPSS.Forty-three patients were included. The following CYP11B2 staining patterns were identified: (1) single adenoma; (2) aldosterone producing nodule(s) or micronodule(s); (3) combination of type 1 and type 2; (4) hyperplasia; and (5) aldosterone-producing adrenocortical cancer. In total, 23 of 43 revealed CYP11B2 staining in a single adenoma only. Staining in 3/23 involved a portion of the adenoma. 4/9 patients age <40 had areas of CYP11B2 staining in nonadenomatous tissue. Complete biochemical cure was noted in 37 of 43 (86%) and complete clinical cure in 23.2%. There were no differences between staining pattern and sex, race, or age. CYP11B2 staining pattern did not correlate with early clinical or biochemical outcomes.Adrenalectomy specimens from patients treated for primary aldosteronism reveal multiple CYP11B2 staining patterns, including in nonadenomatous tissue in many patients. The impact of these patterns on clinical outcomes requires additional investigation. Uniform categorization of staining patterns will allow for consistent reporting across studies.