肾动脉狭窄与低血钠-高血压综合征的临床分析

Clinical analysis of 9 cases of hyponatremic hypertensive syndrome

目的收集和分析肾动脉狭窄与低血钠-高血压综合征患者的临床特点。方法回顾性分析2001～2（）11年我院住院治疗的肾动脉狭窄、低血钠-高血压综合征。结果9例患者符合低血钠-高血压综合征的入选标准。除2例患者外，均为规律吸烟患者。所有患者中，8例患者与肾动脉粥样硬化有关，1例患者与纤维肌性发育不良有关。血管紧张素II和血浆醛固酮水平明显升高，而且与患者的最低血钠浓度呈明显负相关（r=-0．90，P〈0．01；r=-0．81，P〈0．05）。结论低血钠-高血压综合征的主要病因是动脉粥样硬化导致的肾动脉狭窄。肾素-血管紧张素系统激活可能是低血钠-高血压综合征病理生理机制的核心。该病是肾动脉狭窄的少见并发症，但值得临床医生提高认识和进一步研究。

Objective To collect and analyze the clinical characteristics of patients with hy- ponatremic hypertensive syndrome（HHS）. Methods Patients with HHS presenting between 2001 and 2011 in the affiliated hospital of Qingdao University School of Medicine were retrospectively analyzed. Results A total of 9 cases fulfilled the inclusion criteria of HHS. Among of them, six patients were male with a mean age 61 years and three were female of mean age 51 years. All were regular smokers except for 2 cases. As to the etiology, 8 cases were related with atherosclerosis, one was associated with fibromuscular dysplasia. Both plasma angiotensin II and aldosterone were elevated, and related inverse- ly to the lowest recorded plasma sodium level （r= - 0. 90,P（0. 01 ;r= - 0. 81 ,P（0. 05）. Conclusions HHS was commonly caused by atherosclerotic renal artery stenosis which may be closely related with smoking. Intense activation of the renin-angiotensin system might be the central to the pathophysiology of the HHS. The syndrome is a rare complication of renal artery stenosis,and deserves better recogni- tion and further investigations.