Application Of CXCR4 Immunohistochemistry In The Histopathological Diagnosis Of Primary Aldosteronism

Background:Primary aldosteronism(PA)is one of the common causes of secondary hypertension,and its treatment depends on the subtype diagnosis.Limited by factors such as technology and expense,most of the time,imaging features are used as the criterion for judging the type of PA,which decides whether the patient should be treated with medication or surgery,Routine pathological diagnosis cannot make functional diagnosis of the adrenal gland lesions,which may lead to missed diagnosis and misdiagnosis of patients.Objective:This study will explore the clinical characteristics of PA patients with different imaging manifestations.The value of aldosterone synthase(CYP11B2)and chemokine receptor 4(CXCR4)in the pathological diagnosis and typing of PA patients are also explored by immunohistochemical staining.Methods:A total of 160 patients with primary aldosteronism who were admitted to our hospital from November 2015 to November 2021 were selected and divided into adenoma group,hyperplasia group and normal group according to imaging findings.Patient data were collected and analyzed statistically.At the same time,39 patients who were diagnosed with PA and underwent adrenal surgery in our hospital and 5 patients with adrenal nonfunctioning adenoma were selected,and their postoperative adrenal tissues were subjected to immunohistochemical staining for CYP11B2 and CXCR4,and the staining results were scored semiquantitatively.Results:1.The patients with PA had an average age of 58.72±11.15 years old,and most of them were in the age group of 51-60 years old,with a total of 60 cases,accounting for 37.5%.The median duration of the hypertension was 10(12)years.There were 102 patients with hypokalemia(63.75%).2.There were statistically significant differences in age,serum potassium,plasma aldosterone concentration(PAC),plasma renin concentration(PRC),aldosterone renin ratio(ARR),serum sodium and carbon dioxide combining power(CO2CP)among patients with different imaging manifestations(P<0.05).There were no differences between groups in gender,hypertension course,past medical history,angiotensin Ⅱ,blood calcium,uric acid,serum creatinine,estimated glomerular filtration rate,total cholesterol,triglyceride,low density lipoprotein-cholesterol,high density lipoproteincholesterol,homocysteine,fasting plasma glucose,hemoglobin A1C(P>0.05).3.The age and serum potassium of the adenoma group were lower than the hyperplasia group and the normal group,while the PAC,serum sodium and CO2CP were higher than the hyperplasia group.Both the differences were statistically significant(P<0.05).Regardless of the adenoma group or the hyperplasia group,the different location of the lesion did not affect the biochemical indexes of the patients,and there was no difference in the laboratory indexes of each subgroup(P>0.05).4.The specific staining of CXCR4 and CYP11B2 was observed in adrenal lesions,and there was a correlation between them.The two indicators of CYP11B2 and CXCR4 were used to jointly diagnose PA.When CXCR4≥2 points and CYP11B2=3 points,the area under curve ROC was 0.895,P<0.0001,and the 95%confidence interval was(0.765-0.967).The sensitivity was 97.44%and the specificity was 80%.5.The immunohistochemical staining of CYP11B2 had no statistical significance in the distinction between adenoma and nodular hyperplasia.When CXCR4>1 point,the area under curve ROC for the diagnosis of adenoma was 0.859,P<0.0001,and the 95%confidence interval was(0.7110.950).The sensitivity was 80.77%,and the specificity was 84.62%.Conclusions:1.PA patients with adenomas on imaging have more typical clinical manifestations.,with lower serum potassium and renin,and higher aldosterone and ARR.2.Adrenal lesions in different parts had no significant effect on the biochemical indexes of patients.3.CYP11B2 combined with CXCR4 immunohistochemical staining can be used for pathological diagnosis of PA patients,with a sensitivity of 97.44%and a specificity of 80%4.CXCR4 immunohistochemical staining can be used to diagnose the adenoma and hyperplasia in PA patients,while there was no difference in CYP11B2 staining.