88例原发性醛固酮增多症临床回顾分析

Primary aldosteronism ：a retrospective analysis of 88 cases

目的提高对原发性醛固酮增多症（简称原醛）的诊治水平。方法回顾性分析88例原醛患者的临床资料。结果血压水平、血浆醛固酮浓度（PAC）升高，血浆肾素活性（PRA）、血清钾离子浓度下降。醛固酮瘤占84．09％，特发性醛固酮增多症（简称特醛症）占15．91％。95．45％患者的血浆醛固酮／血浆肾素活性比值（ARR）〉20。醛固酮瘤患者具有更高的血浆醛固酮水平及更低的血浆肾素活性和血清钾离子浓度。结论ARR是原醛的重要筛查方法；卧立位试验及CT有助于肾上腺皮质腺瘤和增生的鉴别。

Objective To elevate the diagnosis and treatment of primary aldosteronism. Methods 88 cases of primary aldosteronism were reviewed. Result To all the patients, the average levels of SBP- max and DBPmax were（ 187.66 ± 3.03 ） mm Hg and（ 113.14 ± 1.78 ） mm Hg respectively. The mean value of plasma renin activity（PRA） and Plasma aldosterone concentration（PAC） were（ 123.42 ± 20.17 ）pmol · L^-1 · h^-1 and（690.03 ± 39.10）pmol · L^-1 severally. Of the 88 patients,95.45% had PAC/PRA （ARR） above 20.84.09% of the patients were caused by aldosterone producing adenoma（APA） and 15.91% were caused by idiopathic hypersteronism （IHA）. Serum potassium was lower in APA as compared to IHA 3.22 mmol· L ^- 1 vs 3.74 mmol· L ^- 1 （ p 〈 0. 05 ）. The PRA of the APA was lower than the IHA as well,37.20 pmol · L ^- 1· h^ -1 vs 96.51 pmol · L^- 1 · h ^- 1 （ p 〈 0.05 ）. The PAC of APA was higher than the IHA 679.70 pmol · L ^- 1 vs 477.49 pmol · L ^- 1 （ p 〈 0.05 ） correspondingly. Spironolactone test was positive in all patients. Conclusions ARR plays the important role in screening of PA. Postural stimulation test and CT were helpful to differentiate aldosterone producing adenoma and idiopathic aldosteronism.