原发性醛固酮增多症患者左室肥厚和颈动脉硬化的发生及相关性

Left ventricular hypertrophy and carotid atherosclerosis in patients with primary aldosteronism

目的探讨原发性醛固酮增多症（PA）患者左室肥厚和颈动脉粥样硬化的情况。方法选取确诊的PA患者32例（PA组，腺瘤22例、增生10例），同期另择原发性高血压患者20例作为对照组，分别测定其生化指标、血醛固酮（ALD）浓度、血浆。肾素活性（PRA）；并行颈动脉B超及心超检查，测定颈动脉内膜中层厚度（IMT）及左室肥厚情况。结果（1）两组患者仅K^＋、LVMt、IMT差异明显（P〈0．05），其他指标均无明显差异（P〉005）。PA组发生左室肥厚22例（68．75％）；形成颈动脉斑块10例（31．25％）。对照组发生左室肥厚8例（40．00％）；形成颈动脉斑块3例（15.00％）。PA组左室肥厚发生率明显高于对照组（P〈0.05），颈动脉斑块发生率较之对照组无明显差异（P〉0.05）。（2）PA组中两类患者各指标的差异均无统计学意义（P〉0.05）。腺瘤患者发生左室肥厚16例（72.73％）；形成颈动脉斑块6例（27.23％）。对照组发生左室肥厚6例（60.00％）；形成颈动脉斑块4例（40.00％）。两类患者左室肥厚和颈动脉斑块发生率均无明显差异（均P〉0.05）。（3）PA患者中，剔除病程、收缩压、Cr的影响，LVMI与卧位及立位ALD浓度均呈正相关（均P〈0.05）；控制病程、年龄、收缩压、血糖、甘油三脂、总胆固醇等危险因素，IMT与卧位及立位ALD浓度均显著相关（均P〈0.05）。结论PA患者LVMI高于EH患者，左室肥厚发生率增加，颈动脉粥样硬化程度较EH患者严重。

Objective To evaluate left ventricular hypertrophy （LVH） and carotid atherosclerosis in patients with primary aldosteronism （PA）. Methods Thirty two patients with PA, including 22 cases of adenomas （APA） and 10 cases of idiopathic hyperaldosteronism （IHA）, were included in this study. Clinical characteristics, left ventricular mass index （LVMI） and carotidartery intima-mean thickness （iMT） were assessed in 32 PA patients and 20 matched controls with essential hypertension （EHT）. Results There were no differences in plasma basic glucose, creatinine, triglycerides, total cholesterol and high-density lipoprotein between the groups. Plasma potassium was lower （2.87 ± 0.65 vs. 4.12 ± 0.44 mmol/l; P 〈 0.01） in PA patients. Patients with PA had higher LVMI （122.99 ± 16.53 vs. 114.29 ± 12.55 g/m^2; P 〈 0.05） and LVH was more frequent in those patients （P 〈 0.05）. Carotid IMT was significant greater in FA patients than in EHT patients （1.15 ± 0.20 vs. 1.03 ± 0.19 mm; P 〈 0.05）. By multivariate analysis, the concentrations of basic and upright plasma aldosterone independently predicted LVMI and carotid IMT after adjustment for all potential confounders. There were no differences in LVMI and IMT between APA patients and IHA patients. Conclusion The results suggest that the prevalence of LVH is higher and carotid atherosclerosis is more serious in PA patients. The concentration of plasma aldosterone is strongly associated with LVH and early carotid atherosclerosis among PA patients.