首页 中华内分泌外科杂志 2025年19卷01期 肾上腺静脉取血操作规范和结果解读专家共识（2025年版）
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肾上腺静脉取血操作规范和结果解读专家共识（2025年版）
中国医师协会内分泌代谢科医师分会肿瘤内分泌学组
中国内分泌性高血压协作组
作者及单位信息
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DOI： 10.3760/cma.j.cn115807-20250103-00003
Expert consensus on the operation specifications and result interpretation of adrenal vein sampling
Tumor Endocrinology Group of Endocrinology and Metabolism Branch of Chinese Medical Doctor Association
Endocrine Hypertension Collaboration in China
Yang Shumin
Authors Info & Affiliations
Tumor Endocrinology Group of Endocrinology and Metabolism Branch of Chinese Medical Doctor Association
Endocrine Hypertension Collaboration in China
Yang Shumin
Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Disease, Chongqing 400016, China
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DOI： 10.3760/cma.j.cn115807-20250103-00003
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摘要
肾上腺静脉取血被国内外指南/共识推荐用于原发性醛固酮增多症的分型诊断。为促进肾上腺静脉取血操作过程标准化和结果解读规范化，来自国内内分泌科和泌尿外科等相关领域专家，基于近年来的相关研究进展，围绕肾上腺静脉取血患者的选择、术前准备、手术方式、结果判读、术后注意事项及并发症处理等方面进行归纳总结，制定本共识，旨在提升临床医生对原发性醛固酮增多症的诊治水平。
肾上腺静脉取血;原发性醛固酮增多症;肾上腺;继发性高血压
ABSTRACT
Adrenal vein sampling (AVS) is recommended by domestic and foreign guidelines/consensus for the classification of primary aldosteronism. In order to promote the standardization of adrenal vein sampling procedures and the interpretation of AVS results, experts from endocrinology, urology and other related fields, based on the relevant research progress in recent years, summarized the selection of AVS patients, preoperative preparation, AVS methods, interpretation of AVS results, postoperative precautions and complications management, and formulated this consensus. The aim is to improve the ability of doctors in the diagnosis and treatment of primary aldosteronism.
Adrenal vein sampling;Primary aldosteronism;Adrenal glands;Secondary hypertension
Yang Shumin, Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Disease, Chongqing 400016, China, Email:
mocdef.qabq494860344
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引用本文
中国医师协会内分泌代谢科医师分会肿瘤内分泌学组,中国内分泌性高血压协作组. 肾上腺静脉取血操作规范和结果解读专家共识（2025年版）[J]. 中华内分泌外科杂志,2025,19(01)：1-7.
DOI:10.3760/cma.j.cn115807-20250103-00003PERMISSIONS
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原发性醛固酮增多症（primary aldosteronism，PA，简称"原醛症"）是继发性高血压的常见类型，占高血压患者的4.0%~11.2%
[
1
,
2
,
3
]。与原发性高血压患者相比，原醛症患者的心血管疾病相关风险显著增加
[
4
]。原醛症可根据肾上腺病变部位分为单侧原醛症和双侧原醛症，通常建议单侧原醛症患者首选手术治疗，而双侧原醛症患者宜选口服盐皮质激素受体拮抗剂治疗
[
5
,
6
]。一项Meta分析研究显示，相较于药物治疗，手术治疗可显著降低原醛症患者心血管疾病风险及死亡风险
[
7
]。可见，对原醛症患者进行准确分型至关重要。原醛症的常用分型方法包括肾上腺CT和肾上腺静脉取血（adrenal vein sampling，AVS），其中AVS是国内外指南或共识推荐的原醛症分型的"金标准"
[
5
,
6
,
8
,
9
]。近年来，多项研究报道
68Ga-Pentixafor PET/CT有助于原醛症分型
[
10
,
11
,
12
,
13
,
14
]，但其具体临床应用尚待进一步研究。
AVS是经皮穿刺外周静脉置管，然后经导管插入肾上腺静脉采集血样，通过测定血样中的醛固酮、皮质醇等肾上腺激素水平，从而判断双侧肾上腺激素分泌情况的一种有创检查。Johnstone等
[
15
]于1957年首次报道了肾上腺静脉的解剖结构。James等于1967年首次在《新英格兰医学杂志》报道了AVS定位醛固酮瘤的方法
[
16
]。随后，Weinberger等
[
17
]在1979年首次提出促肾上腺皮质激素（adrenocorticotropic hormone，ACTH）兴奋的AVS以减少术中激素波动对结果的影响。随着AVS技术的推广，John等于1996年提出AVS双侧同步取血，以减少因操作时间导致两侧肾上腺静脉激素浓度的差异
[
18
]。
尽管AVS是原醛症分型的关键技术，但其开展并不广泛
[
19
]。一项回顾性多中心国际研究表明，即使是一些大型医疗中心也未常规开展AVS
[
20
]。可能的原因包括：①AVS技术难度较大，开展初期失败率较高，易使操作者失去信心
[
21
]；②AVS是一种有创操作，存在一定的手术风险，且费用较高，目前国内需住院才能完成，部分患者不愿意完善该检查。此外，AVS的操作过程及判断方式未标准化，不同医疗中心的AVS操作流程不同
[
20
,
22
]，结果判读的异质性高，可能也会影响AVS的推广。
尽管AVS也可用于其他肾上腺疾病的定位诊断，但本共识仅对原醛症的AVS进行总结，旨在促进该技术操作过程标准化和结果解读规范化。为此，中国医师协会内分泌代谢科医师分会肿瘤内分泌学组、中国内分泌性高血压协作组组织国内内分泌科、泌尿外科、心血管科、介入科等相关领域专家成立共识专家组。采用共识制定会议法，专家组成员结合最新相关文献和多个中心的临床经验，针对性讨论并制定撰写了《肾上腺静脉取血操作规范和结果解读专家共识（2025年版）》，旨在为我国原醛症患者的AVS技术操作过程标准化和结果解读规范化提供指导与参考，以进一步提高原醛症诊治水平，改善患者预后。本共识已在国际实践指南注册与透明化平台（practice guide-line registration for transparency，PREPARE）注册（注册号：PREPARE-2024CN1053）。
本共识参考推荐分级的评估、制定与评价标准（grade of recommendations assessment, development, and evaluation，GRADE）表述推荐强度及证据质量。强推荐使用"推荐"和数字1表示，弱推荐使用"建议"和数字2表示。证据质量: ●○○○表示极低质量证据，●●○○表示低质量证据，●●●○表示中等质量证据，●●●●表示高质量证据。通常按照"强推荐"进行处理利大于弊，"弱推荐"则需根据患者个体情况来决定最佳方案。
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备注信息
A
杨淑敏，重庆医科大学附属第一医院内分泌内科，代谢性血管疾病川渝共建重点实验室，重庆 400016，Email:
mocdef.qabq494860344
B
PREPARE-2024CN1053
C
PREPARE-2024CN1053
D
所有作者声明不存在利益冲突
E
国家重点研发计划"常见多发病防治研究"重点专项 (2022YFC2505300)
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