静脉注射速尿激发试验对腺瘤型原发性醛固酮增多症患者的影响

The Change of the Plasma Aldosterone Renin Activity Ratio(ARR)after Furosemide Intravenous Injection in Refractoriness Hypertension and Primary Aldosteronism Patients

目的比较顽固性高血压(高血压)患者与原发性醛固酮增多症(原醛)患者大剂量速尿静脉注射激发试验对血浆醛固酮/肾素比值(ARR)的影响。方法20例顽固性高血压患者和19例原醛患者入选,在清晨平卧时抽取空腹血后静脉快速注射速尿40mg,注射后10、30min各抽血一次查血浆醛固酮(ALD)及肾素(PRA)水平,并计算出ARR。结果顽固性高血压患者的平均空腹血浆ALD(127.5±13.62)pg/ml,PRA为(4.2±0.96)ng/ml/h,ARR为8.1±1.3,静脉注射速尿40mg以后10、30min患者的血浆PRA迅速升高,高峰在10min时,分别为(5.81±1.12),(95.56±1.21)ng/ml/h,P值均小于0.05,有统计学意义。PRA的上升幅度大于ALD的上升幅度,ARR反而有所下降,(6.02±1.2;6.5±1.58)。原醛组的平均空腹ALD165.75±18.56;PRA2.16±0.4;ARR26.61±9.16。ARR明显高于顽固性高血压组,P<0.01。静脉注射速尿后PRA上升不明显,ARR变化不大。两组比较P<0.05。结论顽固性高血压患者ARR比值明显大于原醛患者。静脉快速注射速尿可快速激发顽固性高血压患者的PRA的增加,PRA以10min时最为明显,但原醛患者PRA及ARR增加均不明显。ALD两组均有持续上升趋势。

Objective To study the change of the ratio of plasma aldosterone and renin activity（ARR） after 40mg furosemide intravenous injection in refractoriness hypertension and primary aldosteronism patients. Methods 20 cases with refractoriness hypertension and 19 cases with primary aldosteronism were examined. the change of ALD, PRA and ARR before and after 10min, 30min by 40mg furosimide intravenous injection. Results Before injection in hypertension group ALD is 127.5 ± 13.62pg/ml, PRA is 4.2 ± 0.96pg/ml, ARR 8.1 ± 1.3, 10min, 30min after injection PRA 5.81 ± 1.12, 5.56 ± 1.21ng/ml/h, respectively, P 〈 0.05. But the ARR is decreased because the increase of PRA is more than ALD＇ s. The peak of PRA is at the 10min, but ALD at 30min. In primary aldosteronism group before injection ALD is 165.75 ± 18.56; PRA 2.16 ± 0.4; ARR 26.61 ±9.16. ARR is higher than that in hypertension group （P 〈0.01）. After injecting furosemide the rise of PRA is not significant, the change of ARR is not obvious. Conclusion ARR is higher in primary aldo-steronism group than in hypertension group. After 40mg furosemide intravenous injection PRA increased quickly in hypertension group, the peak of PRA is at 10min, but it did not happen in primary aldoteronism group. After injection furosemide ALD is increased in both groups, the peak is at 30 min.