Lancet Diabetes Endocrinol :简单尿检更准确发现肾上腺癌,有望纳入指南

2020-08-11 药明康德内容团队 医学新视点

近日发表在《柳叶刀-糖尿病与内分泌学》上的一项新研究发现,结合常规影像检查,对携有肾上腺肿块的患者进行简单的尿液检测,有助于加速肾上腺癌诊断,改善患者预后,并减少对侵入性诊断手段的需求。

近日发表在《柳叶刀-糖尿病与内分泌学》(The Lancet Diabetes & Endocrinology )上的一项新研究发现,结合常规影像检查,对携有肾上腺肿块的患者进行简单的尿液检测,有助于加速肾上腺癌诊断,改善患者预后,并减少对侵入性诊断手段的需求。

随着CT和MRI扫描这样的影像技术在临床上的应用日益频繁,它们常常会导致一个意外发现:在肾上腺中发现结节。这些所谓的肾上腺偶发瘤大多无害,尽管如此,一旦发现肾上腺肿块,很重要的一点是:需要查一查是否有可能是肾上腺癌或肾上腺激素过量。

肾上腺皮质癌(ACC)是一种原发于肾上腺皮质的恶性肿瘤,ACC患者预后很差,只有通过早期发现和手术才有可能治愈。一般情况下,偶然发现的肾上腺肿块常常会导致更多的影像检查,以确定该肿块是否癌变。然而,近来的研究已经表明,影像检查在确定肿块是恶性还是良性方面的能力有限。此外,还会导致成本上升、辐射暴露,并引发患者的焦虑。

本项由英国伯明翰大学(University of Birmingham)专家领衔的研究表明,利用尿液类固醇代谢组学(USM),通过一个简单的尿液检测来测量肾上腺类固醇激素是否过量(肾上腺肿瘤的一个关键指标),便可以加速诊断,让那些不幸罹患ACC的患者尽快接受治疗,同时帮助携有无害肾上腺肿块的患者避免不必要的手术。

在6年的时间里,研究人员对来自欧洲肾上腺肿瘤研究网络 (ENSAT) 14个中心的2000多名新诊断肾上腺肿瘤患者进行了研究。在确诊后,患者收集了一份尿液样本,然后研究人员分析了尿液中肾上腺类固醇的类型和数量,并由基于机器学习的计算机算法进行自动分析。结果表明,比起影像检查,尿液检测错误更少——影像检查常常把ACC误诊为无害的肾上腺结节。

参与该研究的伯明翰大学诊断测试专家Alice Sitch博士和Jon Deeks教授说:“本研究表明,将肿瘤大小、成像特征与尿液检测结合起来,特别是在肾上腺肿块较大且出现可疑影像结果时应用尿液检测,可以提供相当高的准确性。”

论文共同第一作者、美国梅奥诊所(Mayo Clinic)内分泌学副教授Irina Bancos则表示:“这项研究的发现后续将被纳入肾上腺肿瘤治疗的国际指南,新检测的实施将有望改善肾上腺肿瘤患者的总体前景。”

原始出处:

Irina Bancos, Angela E Taylor, Vasileios Chortis, et al.Urine steroid metabolomics for the differential diagnosis of adrenal incidentalomas in the EURINE-ACT study: a prospective test validation study.Lancet Diabetes Endocrinol. 2020 Jul 23;S2213-8587(20)30218-7. doi: 10.1016/S2213-8587(20)30218-7.

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    2020-11-30 howi
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    2020-08-27 14818eb4m67暂无昵称

    学习了

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  9. [GetPortalCommentsPageByObjectIdResponse(id=1902477, encodeId=0b0219024e7b9, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Fri Feb 05 12:05:17 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761490, encodeId=20841e61490d1, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Mon Aug 31 13:05:17 CST 2020, time=2020-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1830779, encodeId=c35a1830e79db, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Mon Nov 30 21:05:17 CST 2020, time=2020-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1639575, encodeId=a34f16395e564, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Mon May 24 10:05:17 CST 2021, time=2021-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691220, encodeId=6ff016912202a, content=<a href='/topic/show?id=40d882430a0' target=_blank style='color:#2F92EE;'>#肾上腺癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82430, encryptionId=40d882430a0, topicName=肾上腺癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=12df29182896, createdName=mhzhuang@stu.e, createdTime=Fri Jun 04 16:05:17 CST 2021, time=2021-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1895214, encodeId=d4e81895214af, content=<a href='/topic/show?id=ce478241e0b' target=_blank style='color:#2F92EE;'>#肾上腺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82417, encryptionId=ce478241e0b, topicName=肾上腺)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dba135, createdName=xuyong523, createdTime=Sat Jul 24 07:05:17 CST 2021, time=2021-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813693, encodeId=293a8136934b, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=64245268311, createdName=14818eb4m67暂无昵称, createdTime=Thu Aug 27 07:52:49 CST 2020, time=2020-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1511533, encodeId=dac71511533a4, content=<a href='/topic/show?id=a2724e42925' target=_blank style='color:#2F92EE;'>#尿检#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47429, encryptionId=a2724e42925, topicName=尿检)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=207610348585, createdName=ms2999106592497887, createdTime=Thu Aug 13 02:05:17 CST 2020, time=2020-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1033923, encodeId=3a211033923c1, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Tue Aug 11 14:05:17 CST 2020, time=2020-08-11, status=1, ipAttribution=)]
    2020-08-11 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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