甲状腺相关眼病氧化应激机制研究

甲状腺相关眼病(Thyroid associated ophthalmopathy,TAO)是一种与甲状腺关系密切、以眼球后结缔组织肿胀为病理特征、以眼球突出为主要临床表现的器官特异性自身免疫疾病。目前对于TAO的发病机制仍未完全阐明,国内外的专家、学者从氧化应激的角度对TAO的发生、发展进行了深入的研究和探索,现将这方面的研究现状综述如下。     

Graves眼病合并真菌性角膜感染1例

报道1例应用大剂量糖皮质激素治疗Graves眼病后导致的真菌性角膜感染。一位31岁的甲状腺机能亢进同时伴有双眼突出的女性,视力下降、眼睑浮肿。首先应用抗甲状腺药物(甲巯咪唑),1个月后,突眼症状无改善,遂给予大剂量甲强龙冲击和曲安奈德球后注射以减轻症状。3个月后,该患者出现角膜溃疡,双眼无光感。1周后体温升高,最高达39.5℃,给予抗菌治疗后体温仍波动在36.7～37.3℃之间。角膜溃疡分泌物涂片可见真菌芽孢和菌丝,予甲亢、抗真菌和营养支持治疗。1个月后,患者双眼睑浮肿减轻、角膜溃疡面积减少,视力恢复到可有光感,体温降至正常。     

激素冲击治疗联合放疗对中重度Graves 眼病临床疗效分析

目的:探讨激素冲击治疗联合放疗用于中重度Graves眼病的临床疗效。方法:将2014年2月~2015年6月之间我院收治的109例中重度Graves眼病患者随机分为A组(n=37)、B组(n=35)、C组(n=37)。A组患者单纯采用抗甲状腺药物治疗,B组患者则在A组的基础上进行激素冲击治疗,C组患者则采用B组基础上联合球后放疗方案治疗,所有患者治疗后保持随访至少6个月,对比三组疗效,记录三组患者治疗前、治疗6个月时的临床活动评分(CAS)及眼球突出度,及随访期间不良反应情况。结果:三组有效率比较,C组B组A组,差异有统计学意义(P0.05)。治疗后三组CAS评分均显著优于治疗前(P0.05),且C组显著低于A、B组(P0.05),A、B组间比较无显著差异(P0.05)。治疗后B、C组眼球突出度显著低于治疗前(P0.05),且C组显著低于A、B组(P0.05)。A、B、C三组不良反应发生率分别为0、14.29%、5.41%,A、C组比较无显著差异(P0.05),B组不良反应发生率明显高于A、C组(P0.05)。结论:激素冲击联合放疗治疗中重度Graves眼病具有显著的疗效,能够有效降低患者的CAS评分及眼球突出度,效果明显优于单纯抗甲状腺治疗或激素冲击治疗,且安全性较好,值得在临床上推广和应用。     

非侵入式眼表综合分析仪在甲状腺相关眼病合并干眼患者评估中的应用价值

目的评估非侵入式眼表综合分析仪在甲状腺相关性眼病伴干眼患者相关眼表指标中的应用价值。方法选择61例(122眼)甲状腺相关性眼病合并干眼患者作为研究对象,测量患者的眼球突出度及上睑退缩量,结合眼表疾病指数量表(OSDI量表)评估干眼情况,并使用非侵入式眼表综合分析仪进行首次泪膜破裂时间(NITBUTf)、平均泪膜破裂时间(NITBUTav)、泪河高度、脂质层评分和睑板腺评分进行检查,并采用Pearson进行相关分析评价各指标与非侵入式眼表综合分析仪测量结果之间的关系。结果 61例122眼的眼球突出度为(16.8±2.15)mm,OSDI评分为(2.17±1.53)分,泪河高度为(0.11±0.13)mm,NITBUTf为(2.11±1.27)s,NITBUTav为(4.11±1.67)s,脂质层评分为(1.332±1.05)分,睑板腺评分为(0.81±0.75)分。NIBUTf、NIBUTav、脂质层评分与眼球突出度呈负相关(均P0.05);泪河高度、睑板腺评分与眼球突出度均无相关性(均P0.05);NIBUTf、NIBUTav、脂质层评分与OSDI评分呈负相关(均P0.05);睑板腺评分与OSDI评分呈正相关(P0.05);泪河高度与OSDI评分无相关性(P0.05)。结论非侵入式眼表综合分析仪的NIBUTf、NIBUTav、脂质层评分在甲状腺相关性眼病合并干眼患者中具有重要的辅助诊断价值,泪膜稳定性是甲状腺相关性眼病患者干眼形成的重要因素。     

脉搏波传导速度在冠心病诊断及冠状动脉狭窄程度评估中的临床应用

目的:研究臂踝脉搏波传导速度(baPWV)在冠心病患者中的诊断价值,并观察臂踝脉搏波传导速度改变(baPWV%)对冠状动脉狭窄程度评估的作用,为临床诊疗提供依据。方法:选取2013年7月-2015年9月我院预行冠状动脉造影患者463例,根据冠状动脉造影情况将入选者分为冠心病组(n=262)和非冠心病组(n=201),冠心病组根据SYNTAX评分将患者分为轻、中、重度组,所有入选者均行baPWV和baPWV%检查,并分析其与SYNTAX评分的相关性。结果:冠心病组baPWV和baPWV%均显著高于非冠心病组,比较差异具有统计学意义(P0.05);重度组baPWV和baPWV%显著高于中度组和轻度组,中度组baPWV和baPWV%显著高于轻度组,比较差异具有统计学意义(P0.05);相关性分析显示:baPWV%与SYNTAX评分呈正相关关系(P0.05)。结论:baPWV和baPWV%对冠心病具有一定诊断价值,且baPWV%与SYNTAX评分呈正相关关系。     

泌尿系造影联合彩色多普勒对小儿先天性肾积水的诊断价值评估

摘要 目的：探讨泌尿系造影联合彩色多普勒对小儿先天性肾积水的诊断价值。方法：选取2018年11月～2021年11月在本院治疗的88例先天性肾积水患儿为研究对象,所有患儿均完善静脉肾盂造影及彩色多普勒超声检查,以病理诊断结果为金标准,对比两种检查方法对小儿先天性肾积水的诊断价值。结果：彩色多普勒超声检查结果显示,肾积水轻度、中度、重度患儿分别为10例、39例、39例,不同病情程度患儿比较,重度组收缩期峰值速度（PSV）、舒张期最小流速（EDV）均低于中度组和轻度组,重度组血流阻力指数（RI）高于中度组和轻度组（P<0.05）,但轻度组与中度组PSV、EDV、RI比较差异无统计学意义（P>0.05）。与病理学诊断检查结果对比,彩色多普勒超声对中度、重度先天性肾积水患儿具有较高的诊断效能,其准确度分别为90.91%、93.18%,与病理诊断kappa值分别为0.795、0.862,具有较高的一致性;但对轻度肾积水诊断效能较低,kappa值为0.629,一致性一般。静脉肾盂造影对轻度先天性肾积水患儿具有较高的诊断效能,准确度为96.59%,与病理诊断kappa值为0.824,具有较高的一致性;但对中度、重度肾积水诊断效能较低,kappa值分别为0.583、0.565,一致性一般。彩色多普勒超声联合静脉肾盂造影诊断准确率高达94.32%,明显高于两检查方法单独应用（P<0.05）。结论：不同病情程度的先天性肾积水患儿具有不同超声征象,彩色多普勒超声对中、重度肾积水患儿具有较好的诊断价值,而静脉肾盂造影诊断轻度肾积水患儿的效能较好,将二者联合可提高对先天性肾积水的诊断准确率。     

妊娠期肝内胆汁淤积症患者外周血清抑制素A水平

目的:研究妊娠期肝内胆汁淤积症患者外周血清抑制素A水平及其与孕酮和雌二醇的相关性。方法:选择2014年1月~2015年9月在我院进行诊治的妊娠期肝内胆汁淤积症患者100例,根据病情程度分为轻度组和重度组,另选择20例健康孕妇为对照组。观察并比较三组血清抑制素A、孕酮和雌二醇水平,及血清抑制素A水平与孕酮和雌二醇的相关性。结果:与对照组相比,轻度组和重度组的血清抑制素A均明显升高(P0.05),且重度组的升高幅度明显大于轻度组(P0.05);与对照组相比,轻度组和重度组的孕酮水平阳性率和雌二醇水平阳性率明显高于正常对照组(P0.05),且重度组明显高于轻度组(P0.05);对照组血清抑制素A水平与孕酮(r=0.15,P0.05)和雌二醇(r=0.21,P0.05)水平不具有明显相关性,轻度组血清抑制素A水平与孕酮(r=0.36,P0.05)和雌二醇(r=0.38,P0.05)水平均呈明显正相关,重度组血清抑制素A水平与孕酮(r=0.57,P0.05)和雌二醇(r=0.59,P0.05)水平均呈明显正相关。结论:血清抑制素A、孕酮和雌二醇可能参与了妊娠肝内胆汁淤积症的发生、发展过程,联合检测血清抑制素A、孕酮和雌二醇有可能成为妊娠肝内胆汁淤积症诊断、分级的新分子标记物。     

婴幼儿呼吸道合胞病毒感染严重程度与基因分型及血清炎症因子水平的相关性

目的探讨婴幼儿呼吸道合胞病毒(respiratory syncytial virus,RSV)感染严重程度与病毒基因分型及血清IL10、IL17、IL27水平的相关性。方法选取2017年3月1日至2018年3月1日我院收治的77例呼吸道合胞病毒感染患儿作为研究对象,对患儿鼻咽部位的分泌物进行取样,对呼吸道合胞病毒亚型和基因型进行检测,按照病情的严重程度,将患者分为轻度组、中度组和重度组。对各组患儿病情程度,RSV亚型分布及血清IL10、IL17、IL27水平进行比较。结果轻度组患儿病情评分为(1.22±0.11)分,中度组为(4.89±0.98)分,重度组为(7.08±0.97)分。77份RSV阳性标本共检出A亚型48例,B亚型29例,其中轻度组、中度组及重度组患者中的A亚型感染人数比例分别为52.17%,60.00%,78.95%。A亚型病毒中NA1型为优势基因型。重度组患儿中NA1型的比例显著高于中度组和轻度组。B亚型病毒中BA9为优势基因型。轻度组患儿BA9型比例显著高于中度组和重度组。轻度组患儿血清IL10、IL17、IL27水平最低,重度组IL10、IL17、IL27的水平最高(均P<0.05)。Spearman相关性分析显示,A亚型病毒感染率与疾病的严重程度呈弱正相关(r=0.28,P=0.031),与IL10、IL17、IL27水平呈显著正相关(r=0.91、0.71、0.82,P=0.015、0.023、0.010)。结论不同病情程度呼吸道合胞病毒感染患儿其病毒基因型分布及血清炎症因子的水平存在显著差异,病毒基因型与疾病的严重程度具有相关性。病毒基因型及血清炎症因子的水平可以作为判断此类患儿病程的标志物。     

动态脑电图与常规脑电图应用于病毒性脑炎诊断的效果分析

目的:探讨动态脑电图与常规脑电图应用于病毒性脑炎的应用价值。方法:选取150例病毒性脑炎患者,随机分为两组,每组各75例,常规脑电图(REEG)组采用常规脑电图检查,动态脑电图(AEEG)组采用动态脑电图检查;观察并记录脑电图异常率,不同程度病情脑电图异常率的例数,评价动态脑电图与常规脑电图对病毒性脑炎的检测灵敏度和准确度。结果:AEEG组检出的脑电图异常率明显高于REEG组(P0.05)。不同程度病情脑电图检出的患者比例,两组相比,差异没有统计学意义(F=-0.085,P0.05)。REEG组中,轻度与中度病毒性脑炎检出率相比,差异没有统计学意义(P0.05),中度与重度病毒性脑炎检出率相比,差异没有统计学意义(P0.05),重度病毒性脑炎检出率明显高于轻度(P0.05)。AEEG组中,轻度与中度病毒性脑炎检出率相比,差异没有统计学意义(P0.05),重度病毒性脑炎检出率明显高于中度和轻度(P0.05),AEEG组重度病毒性脑炎检出率明显高于REEG组(P0.05)。结论:动态脑电图作为一种无创性检查,对于病毒性脑炎具有极好的检出率,灵敏度高,适用于病毒性脑膜炎的早期辅助诊断。     

浅谈甲状腺功能减退性心脏病的临床诊断与治疗

目的:探讨甲状腺功能减退性心脏病的临床诊断情况与治疗效果。方法:回顾性分析30例于我院就诊的甲状腺功能减退性心脏疾病患者的临床资料,并对其临床诊断结果与治疗效果进行分析。结果:本组患者的误诊率和临床疗效总有效率分别为20.00%(6/30)和93.33%(28/30);治疗后患者的FT3、FT4值明显高于治疗前,而治疗后患者的TSH、LAD、LVD、IVST、PWT以及LVEF值明显低于治疗前,差异均具有统计学意义(P0.05)。结论:甲状腺功能减退性心脏病的误诊率较高,应对患者行甲状腺功能检测的同时增加辅助检查,以此来提高诊断的准确性与可靠性。给予甲状腺功能减退性患者有效治疗,能够取得较好的临床治疗效果和预后效果。     

Radiotherapy in the treatment of Graves ophthalmopathy—to do it or not?

To the objective of this study is to evaluate the role and toxicity of radiotherapy in the treatment of Graves ophthalmopathy. In the years 2000–2003, 121 patients with malignant exophthalmos were treated with radiotherapy of the retrobulbar area to the total dose of 20 Gy in ten fractions with a 6 MeV photon beam. The treatment was performed by the team of the Clinic of Oncology of the Jagiellonian University Medical College in Cracow. The radiotherapy was preceded by intravenous steroid therapy: methylprednisolone acetate administered at the dose of 2 g/week for four consecutive weeks. The highest efficacy, expressed as improvement of all ocular symptoms, was observed for the combined treatment. Female and non-diabetic patients responded positively to the combined treatment. Radiotherapy combined with steroid therapy in the treatment of Graves ophthalmopathy seems to be an effective treatment for strictly defined indications. In the treatment of Graves–Basedow disease, radiotherapy is a well-tolerated treatment modality. Diabetes is a factor that worsens prognosis in Graves ophthalmopathy and female sex is a favourable factor for this condition.     

Radiomics analysis of EPID measurements for patient positioning error detection in thyroid associated ophthalmopathy radiotherapy

PurposeElectronic portal imaging detector (EPID)-based patient positioning verification is an important component of safe radiotherapy treatment delivery. In computer simulation studies, learning-based approaches have proven to be superior to conventional gamma analysis in the detection of positioning errors. To approximate a clinical scenario, the detectability of positioning errors via EPID measurements was assessed using radiomics analysis for patients with thyroid-associated ophthalmopathy.MethodsTreatment plans of 40 patients with thyroid-associated ophthalmopathy were delivered to a solid anthropomorphic head phantom. To simulate positioning errors, combinations of 0-, 2-, and 4-mm translation errors in the left–right (LR), superior-inferior (SI), and anterior-posterior (AP) directions were introduced to the phantom. The positioning errors-induced dose differences between measured portal dose images were used to predict the magnitude and direction of positioning errors. The detectability of positioning errors was assessed via radiomics analysis of the dose differences. Three classification models—support vector machine (SVM), k-nearest neighbors (KNN), and XGBoost—were used for the detection of positioning errors (positioning errors larger or smaller than 3 mm in an arbitrary direction) and direction classification (positioning errors larger or smaller than 3 mm in a specific direction). The receiver operating characteristic curve and the area under the ROC curve (AUC) were used to evaluate the performance of classification models.ResultsFor the detection of positioning errors, the AUC values of SVM, KNN, and XGBoost models were all above 0.90. For LR, SI, and AP direction classification, the highest AUC values were 0.76, 0.91, and 0.80, respectively.ConclusionsCombined radiomics and machine learning approaches are capable of detecting the magnitude and direction of positioning errors from EPID measurements. This study is a further step toward machine learning-based positioning error detection during treatment delivery with EPID measurements.     

机化性肺炎患者的CT引导下经皮肺穿刺活检及其临床诊治分析

目的:探讨CT引导下经皮肺穿刺活检对机化性肺炎患者的诊断价值,并总结机化性肺炎的临床诊治经验。方法:回顾性分析2015年7月-2017年9月在南京医科大学附属常州第二人民医院住院行CT引导下经皮肺穿刺活检取得肺部病灶组织确诊为机化性肺炎的14例患者,所有患者行CT引导下经皮肺穿刺活检,总结机化性肺炎患者的临床诊治经验。结果:14例机化性肺炎患者平均年龄为59岁,平均起病时间为21天。主要临床症状以发热、咳嗽、咳痰为主。6例肺部听诊可闻及湿啰音。影像学检查主要表现为肺部斑片状不均匀密度增高影。所有患者初次就诊时均未首先诊断考虑机化性肺炎。所有患者入院后均行CT引导下经皮肺穿刺活检术,术后病理均确诊为机化性肺炎,术中3例出现少量气胸,4例出现少量出血,予吸氧止血等对症处理后好转。14例患者予糖皮质激素治疗后,主要临床症状改善,影像学检查均较前吸收好转。结论:对于持续性干咳、呼吸困难、发热病人,抗生素疗效差,影像学显示片状或块状影病灶,特别是游走性斑片阴影,需要高度警惕机化性肺炎。CT引导下经皮肺穿刺活检可作为明确机化性肺炎诊断的首选方法。机化性肺炎对糖皮质激素治疗敏感,可出现可逆性的好转,一旦确诊,建议及早使用糖皮质激素治疗。     

Use of Methotrexate to Treat Isolated Graves Ophthalmopathy Developing Years After Thyroidectomy and Iodine 131 Treatment of Papillary Thyroid Cancer

ObjectiveTo describe a case of Graves ophthalmopathy developing years after subtotal thyroidectomy and radioactive iodine treatment of papillary thyroid cancer.MethodsWe present a case report including clinical and laboratory data. Current relevant literature is reviewed and summarized with regard to Graves ophthalmopathy.ResultsIn 2001, a 51-year-old woman presented with an asymptomatic thyroid nodule. Fine-needle aspiration biopsy results showed Hürthle cells, and the patient had a subtotal thyroidectomy in 2002. Stage 2 follicular variant of papillary thyroid carcinoma was diagnosed. She received radioactive iodine (I 131) therapy (94.8 mCi and 147.2 mCi) in 2003. Thyrotropin was suppressed with levothyroxine. The patient remained asymptomatic and had undetectable thyroglobulin antibodies. In 2007, her eyes became irritated (ie, erythematous, pruritic, watery). Thyroperoxidase and thyroglobulin antibodies were undetectable, but thyrotropin receptor antibody was elevated to 44% (reference range, < 16%). On physical examination, moderate periorbital edema and conjunctival injection were present; orbital magnetic resonance imaging was normal. Computed tomography of her orbits showed symmetric bilateral exophthalmos and prominence of orbital fat. Other ophthalmologic etiologies were ruled out by 2 independent ophthalmologists. She had minimal improvement with oral and intravenous steroids. Subsequent treatment with methotrexate resulted in marked symptomatic improvement and lowered the thyrotropin receptor antibody level to 24%.ConclusionsIsolated Graves ophthalmopathy in a patient after treatment of thyroid cancer and radioactive iodine ablation has not been previously reported. Methotrexate therapy may be a useful therapeutic approach in this setting. (Endocr Pract. 2008;14:422-425)     

Leptin receptor is a key gene involved in the immunopathogenesis of thyroid-associated ophthalmopathy

Thyroid-associated ophthalmopathy (TAO), the most common and severe manifestation of Graves' disease (GD), is a disfiguring and potentially blinding autoimmune disease. The high relapse rate (up to 20%) and substantial side effects of glucocorticoid treatment further decrease the life quality of TAO patients. To develop novel therapies, we amid to explore the immunopathogenesis of TAO. To identify the key immune-related genes (IRGs) in TAO, we integrated the IRG expression profiles in thyrocytes from a GD patient set (GD vs healthy control) and a TAO patient set (TAO vs GD). Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), protein-protein interaction (PPI) and receiver operating characteristic (ROC) curve analyses identified the leptin receptor (LEPR) gene as the key IRG in TAO immunopathogenesis. Gene set enrichment analysis (GSEA) suggested enrichment of the antigen presentation pathway in TAO patients with higher LEPR. Increased LEPR expression was validated in TAO orbital tissues, and weighted gene co-expression network analysis (WGCNA) showed that cell adhesion processes were positively correlated with LEPR. Our study revealed that LEPR is a key gene in TAO immunopathogenesis and plays different roles in thyrocytes and orbital tissues. Our findings provide new insights into diagnostic and therapeutic biomarkers for TAO.     

Anti-eye muscle antibodies and hypothyroid Graves' disease: a case report.

We report the case of a 70-year-old man who developed hypothyroidism associated with TSH receptor antibodies and severe ophthalmopathy during lithium therapy. He had received lithium therapy for more than 20 years for manic depression, when ophthalmopathy (class VI of the American Thyroid Association classification) and mild hypothyroidism developed. Orbital magnetic resonance imaging indicated marked enlargement of the superior, medial and inferior rectus muscles in the left eye. He had anti-eye muscle antibodies in his serum, detected by Western blotting and quantified by chromatoscanning, as well as anti-TSH receptor antibodies. He was treated with supplementation of levothyroxine and four cycles of methylprednisolone pulse therapy. After the pulse therapy, both anti-eye muscle antibodies and anti-TSH receptor antibodies decreased and disappeared in parallel with the improvement in eye symptoms and signs. These observations suggest the importance of anti-eye muscle antibodies as clinical markers in the development of thyroid-associated ophthalmopathy.     

青少年GATA2缺陷继发骨髓增生异常综合征一例并文献复习

摘要 目的：提高对青少年GATA2缺陷继发骨髓增生异常综合征（MDS）疾病的认识。方法：回顾性分析我院收治的1例青少年GATA2缺陷继发MDS患者的诊疗过程,并结合相关文献进行复习总结。结果：患者男,17岁,2018年6月于我科诊断为MDS(MDS-EB-I,IPSS中危-1;WPSS高危;IPSS-R高危),继发骨髓纤维化。完善血液遗传全外显子基因检查提示患者GATA2基因突变。修正诊断为GATA2缺陷综合征、继发MDS( MDS-EB-I,IPSS中危-1;WPSS高危;IPSS-R高危) 、继发骨髓纤维化。完善患者姐姐血常规检查提示白细胞轻度减少,检查患者姐姐GATA2基因检测到GATA2基因错义突变。患者治疗期间反复出现多部位感染。进一步检查患者父母GATA2基因提示患者父亲GATA2基因存在错义突变。患者GATA2基因突变系父系遗传。结论：对于青少年MDS患者,应对其进行血液遗传学全外显子基因检查以确认其有无先天性疾病;对于存在先天性基因突变的患者,建议行家系筛查,并尽早行造血干细胞移植治疗。     

颅内原发性胚胎性癌的临床特征及预后影响因素分析

目的:探讨颅内原发性胚胎性癌的临床特征及预后影响因素,为该病的临床诊治提供参考依据。方法:回顾性分析我院经病理证实的6例颅内原发性胚胎性癌患者的临床资料,随访并比较患者的预后情况。结果:本组病例5例男性和1例女性,平均年龄9.8岁;5例病变位于松果体区,1例位于鞍区;5例头痛起病,1例表现为多尿;术前血液学检查提示:4例患者甲胎蛋白明显升高,1例患者β亚单位绒毛膜促性腺激素明显升高;3例患者手术全切,平均生存期32.0月,3例患者手术次全切,平均生存期21.0月;4例患者术后接受规范放化疗,平均生存期32.0月,1例仅行化疗,生存期22.0月,1例术后未行放化疗,生存期9.0月。结论:颅内原发性胚胎性癌是一种罕见的颅内肿瘤,多见于年轻男性,病变多位于松果体区;术前血液学检查有助于诊断;患者预后差,手术切除程度是一重要预后影响因素,术后放化疗或可延长患者的生存期。     

分侧肾上腺静脉取血与肾上腺CT对原发性醛固酮增多症诊断的价值比较研究

摘要 目的：研究原发性醛固酮增多症（PA）患者行分侧肾上腺静脉取血（AVS）、肾上腺CT诊断的效果。方法：数据遴选本院2018年1月-2021年11月收治的70例原发性醛固酮增多症患者,所有患者均行肾上腺CT、AVS诊断,对最终诊断结果比较分析。结果：收缩压、舒张压、空腹血糖、总胆固醇在单双侧间无差异（P＞0.05）,双侧肾素活性、血清醛固酮肾素比值较单侧存在差异（P＜0.05）;肾上腺CT与AVS诊断的符合率情况：肾上腺CT显示为单侧异常、双侧异常及双侧正常患者,AVS符合率分别为65.00 %、31.25 %、50.00 %;单独肾上腺CT诊断：灵敏度为57.1 %,特异度为25.7 %,肾上腺静脉采血诊断：灵敏度为74.3 %,特异度为42.9 %;并联联合诊断灵敏度为100.0 %,特异度为26.3 %,串联诊断灵敏度为19.5 %,特异度为100.0 %。结论：PA是临床常见疾病,具有患病率高、预后差等特点,临床依靠临床表现、血液生化检查诊断PA疾病,但仅借助血液生化检验进行诊断治疗较困难,功能定位是治疗关键。实际工作中,可以临床通过CT检查及AVS检查功能定位诊断,但对于PA患者来说,仅借助肾上腺CT诊断结果制定治疗方案,可能导致手术侧选择错误,建议愿意接受肾上腺手术治疗者,推荐先行AVS,正确选择治疗方案,达到改善预后作用,效果较理想、值得临床借鉴推广。