arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2017-23-3-212-223arthyper-643Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL ARTICLEСпособ дифференциальной диагностики основных форм первичного гиперальдостеронизма с применением высокоэффективной жидкостной хроматографииThe method of differential diagnosis of the main forms of primary hyperaldosteronism by high performance liquid chromatographyРеброваД. В.RebrovaD. V.

ассистент кафедры эндокринологии им. акад. В.Г. Баранова 

ул. Кирочная, д. 41, Санкт-Петербург, 191015

Тел.: +7(812)287–29–13

MD, Assistant, Department of Endocrinology named after V.G. Baranov

41 Kirochnaya street, St Petersburg, 191015

endocrinology@inbox.ruВорохобинаН. В.VorokhobinaN. V.

заведующая кафедрой эндокринологии им. акад. В.Г. Баранова

MD, Head, Department of Endocrinology named after V.G. Baranov

БарановВ. Л.BaranovV. L.

профессор кафедры эндокринологии им. акад. В.Г. Баранова

MD, PhD, DSc, Professor, Department of Endocrinology named after V.G. Baranov

ВеликановаЛ. И.VelikanovaL. I.

заведующая научно- исследовательской лабораторией хроматографии

MD, Head, Research Chromatography Laboratory

Федеральное государственное бюджетное образовательное учреждение высшего профессионального образования «Северо-Западный государственный медицинский университет имени И. И. Мечникова» Министерства здравоохранения Российской Федерации, Санкт-ПетербургРоссияNorth-Western State Medical University named after I. I. Mechnikov, St PetersburgRussian Federation201714072017233212223Copyright © Реброва Д.В., Ворохобина Н.В., Баранов В.Л., Великанова Л.И., 20172017Реброва Д.В., Ворохобина Н.В., Баранов В.Л., Великанова Л.И.Rebrova D.V., Vorokhobina N.V., Baranov V.L., Velikanova L.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/643

Цель исследования — разработка способа дифференциальной диагностики основных форм пер- вичного гиперальдостеронизма (ПГА) на основании метода высокоэффективной жидкостной хромато- графии (ВЭЖХ). Материалы и методы. В исследование включены 98 пациентов с ПГА и с эссенциальной артериальной гипертензией (ЭАГ). Уровни альдостерона и активности ренина плазмы измеряли радиоиммунологическим анализом, уровень ренина — иммуноферментным анализом, уровни кортизола (F), кортизона (E), кортикостерона (B), 11‑дезоксикортикостерона (DOC), 11‑дегидроксикортикостерона (А), 11‑дезоксикортизола (S), 18‑гидроксикортикостерона (18‑ОН-В) в крови, экскрецию с мочой свободного кортизола (UFF), свободного кортизона (UFE), 18‑гидроксикортикостерона (U18‑ОН-В) методом ВЭЖХ. Проводились функциональные пробы с дексаметазоном, физиологическим раствором, «маршевой» нагрузкой; компьютерная томография надпочечников с контрастированием. Всем больным с подтвержденным ПГА выполняли сравнительный селективный забор крови из надпочечниковых вен (ССЗВК). Результаты. У пациентов с ПГА установлено повышение уровней B, DOC, 18‑OH-B в крови и экскреции U18‑OH-B с мочой по сравнению с обследованными с ЭАГ по данным метода ВЭЖХ. Кроме того, у пациентов с альдостеромой установлено сочетанное повышение уровней B, DOC, 18‑OH-B в крови и экскреции U18‑OH-B с мочой, у обследованных с идиопатическим гиперальдостеронизмом (ИГА) выявлено снижение соотношений F/E и B/А в крови, UFF/UFE в моче. Наиболее высокие чувствительность и специфичность для подтверждения диагноза ПГА были выявлены при определении B, DOC, 18‑OH-B в крови и экскреции U18‑OH-B с мочой. У больных с альдостеромой выявлено увеличение уровней В и 18‑ОН-В, соотношений B/А, B/F и 18‑OH-B/F в крови из надпочечниковой вены на стороне образования по сравнению с аналогичными показателями у пациентов с ИГА. Выводы. Уровни B, DOC, 18‑OH-B в крови и экскреции U18‑OH-B с мочой, определяемые методом ВЭЖХ, являются информативными и надежными показателями для ранней диагностики ПГА. Использование метода ВЭЖХ в комплексе обследования пациентов с ПГА необходимо при значении альдостерон-ренинового соотношения в диапазоне от 30 до 50 нг/дл на нг/мл/час и при пограничных значениях коэффициента латерализации по данным ССЗВК. 

Objective. To provide a method of differential diagnosis of the main forms of primary hyperaldosteronism (PHA) based on the high effective liquid chromatography (HELC). Design and methods. We evaluated 98 patients with PHA and with essential hypertension (EHTN). Aldosterone and plasma renin activity were measured by radioimmunoassay, renin levels by immunoassay. The blood levels of cortisol (F), cortisone (E), corticosterone (B), 11‑deoxycorticosterone (DOC), 11‑dehydrocortitocosterone (A), 11‑deoxycortisol (S), 18‑hydroxycorticosterone (18‑OH-B), the urinary excretion of free cortisol (UFF), free cortisone (UFE), 18‑hydroxycorticosterone (U18‑OH-B) were measured by HELC. Dexamethasone test, saline infusion test, postural test, computed tomography of adrenal glands were performed. All PHA patients underwent adrenal vein sampling (AVS). Results. PHA patients had higher blood levels of B, DOC, 18‑OH-B and urinary excretion of U18‑OH-B than EHTN patients. Moreover, patients with aldosteroma had combined excess of blood B, DOC, 18‑OH-B and urinary excretion of U18‑OH-B, patients with idiopathic hyperaldosteronism (IHA) showed a reduction of F/E and B/А blood ratios and UFF/UFE urine ratio. The blood levels of B, DOC, 18‑OH-B and urinary excretion of U18‑OH-B showed the highest sensitivity and specificity for the diagnosis of PHA. Patients with aldosteroma showed higher levels of B and 18‑OH-B, higher ratios B/А, B/F and 18‑OHB/F in the adrenal vein blood at the tumor side as compared with those in patients with IHA. Conclusions. B, DOC, 18‑OH-B blood levels and U18‑OH-B urinary excretion determined by HELC are informative and reliable indicators for early diagnosis of PHA. The use of HELC method in a complex examination of PHA patients is necessary in case of aldosterone-renin ratio between 30 and 50 ng/dl per ng/(ml per hour) and in case of borderline values of lateralization coefficient at AVS.

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The authors declare that there are no conflicts of interest present.