40例原发性醛固酮增多症手术前后血压与血液生化改变对比分析

Analysis of the Pre and Post operative Blood Pressure and Blood Biochemical Changes in 40 Cases of Primary Aldosteronism

目的：研究原发性醛固酮增多症患者血压及血液生化改变与手术效果的关系。方法：分析４０例原发性醛固酮增多症患者，其中男１７例，女２３例，年龄１８～５６岁，平均４０．３岁。对手术后病理诊断进行分类，术前术后测定血压，血钾、钠，尿钾，血浆肾素活性、醛固酮并计算醛固酮／肾素活性比值。结果：单纯腺瘤２６例，增生９例，混合５例，术后平均收缩压自２４．０±３．３ｋＰａ（１８０±２５ｍｍＨｇ）降至１７．７±１．９ｋＰａ（１３３±１４ｍｍＨｇ），平均舒张压自１５．６±２．４ｋＰａ（１１７±１８ｍｍＨｇ）降至１１．６±１．２ｋＰａ（８７±９ｍｍＨｇ），血钾自２．８±０．５ｍｍｏｌ／Ｌ升至４．１±０．４ｍｍｏｌ／Ｌ，２４小时尿钾排泄自４９．０ｍｍｏｌ降至２９．８ｍｍｏｌ，血浆肾素活性自０．５０±０．４３ｎｇＡＩｍｌ－１／ｈ升至５．４７±２．６８ｎｇＡＩｍｌ－１／ｈ，血浆醛固酮由３８５．７±２０４．１ｐｇ／ｍｌ降至１２９．０±６１．９ｐｇ／ｍｌ，血浆醛固酮／血浆肾素活性比值由７７３．９降至４６．２。结论：原发性醛固酮增多症患者血液生化改变，对原发性醛固酮增多症诊断及术后疗效判定有重要价值。

Objective:To study the relationship between operative effects,blood pressure and blood biochemical changes in patients with primary aldosteronism. Methods:Pre and post operative blood pressure,serum potassium,plasma aldosterone(PAC),periplasmal renin activity(PRA),aldosterone/PRA ratio and pathomorphological classification were studied in 40 patients with primary aldosteronism. Results:Adenoma(26 cases),proliferation(9 cases)and mixed type (5 cases)were found in this group.Mean systolic blood pressure decreased from 24 0±3 3to 17 7±1 9kPa(180±25 to 133±14mmHg)and mean diastolic blood pressure decreased from 15 6±2 4 to 11 6±1 2kPa(117±18 to 87±9mmHg).Serum potassium increased from 2 8±0 5 to 4 1±0 4 pg/ml and PRA increased from 0 50±0 43 to 5 47±2 68 ng AI·ml -1 /h.PAC/PRA ratio decreased from 773 9 to 46 2. Conclusion:Our results indicated that the abnormal changes of serum potassium,PAC,PRA and PAC/PRA ratio are of significance in the diagnosis and therapeutic evaluation of primary aldosteronism after operation.