正常血钾和伴低血钾库欣病患者心脑血管并发症和临床特点的比较

Cardiovascular and cerebrovascular complications and clinical characteristics of Cushing's disease patients with a normal kalemic level or hypokalemia

目的比较不同血钾水平库欣病患者心脑血管并发症和临床特点。方法回顾性分析1991-2011年在我院诊治的187例成年库欣病患者临床资料,根据血钾正常与否分组,比较两组心脑血管并发症和临床特点。结果患者平均年龄20-76（38.8±11.3）岁,43.3%（81/187）伴有低血钾。与血钾正常组比较,低血钾组男性比例高于女性（P〈0.01）、病程更短（P〈0.01）、血压和血脂水平更高（P〈0.05）;低血钾组紫纹、瘀斑和下肢水肿发生率更高（P〈0.05）,更易发生碱中毒（P〈0.01）;低血钾组血清ACTH、F和24 h UFC均显著高于血钾正常组（P〈0.01）,大剂量地塞米松抑制试验阴性率更高（37.1%vs 9.4%,P=0.00）;低血钾组血管并发症发生率升高（56.8%vs 41.5%,P〈0.05）,其中以心律失常更常见（35.4%vs 21.9%,P〈0.05）,而左室肥厚、心绞痛/心肌梗死发生率均相仿（P〉0.05）;两组脑血管事件发生率未见统计学差异（17.3%vs 20.8%,P〉0.05）;结论伴低血钾者更多见于男性、病程更短、体征更突出、代谢异常更严重、激素水平更高;库欣病患者血管并发症发生率高,尤其是伴低血钾者,以心律失常和蛋白尿为著。

Objective To compare the cardiovascular and cerebrovascular complications and clinical characteristics of Cushing＇s disease patients with different serum potassium levels.Methods Clinical data about 187 adult Cushing＇s disease patients admitted to our hospital from 1991 to 2011 were retrospectively analyzed.The patients were divided into two groups according to their serum potassium level.Their cardiovascular and cerebrovascular complications and clinical characteristics were compared.Results The average age of the patients was 20-76 years（mean 38.8±11.3 years）.Of the 187 patients,43.3%（81/187） were diagnosed with hypokalemia.The number of males was greater than that of females,the course of disease was shorter,the blood pressure and blood lipid level and the incidence of striae,ecchymoses and edema of lower limbs were higher in patients with hypokalemia than in those with a normal serum potassium level（P 〈0.01）.It was easier to occur alkalosis in patients with hypokalemia than in those with a normal serum potassium level（P 〈0.05）.The serum levels of ACTH,F,and 24 h UFC were significantly higher in patients with hypokalemia than in those with a normal serum potassium level（P 〈0.01）.The negative rate of dexamethasone inhibition test and the incidence of complications and arrhythmia were significantly higher in patients with hypokalemia than in those with a normal serum potassium level（37.1% vs 9.4%,56.8% vs 41.5%,35.4% vs 21.9%,P 〈0.05）.No significant difference was found in the incidence of left ventricular hypertrophy,angina pectoris,myocardial infarction,and cerebrovascular events between the patients with a normal serum potassium level and those with hypokalemia（P 〈0.05）.Conclusion Hypokalemia usually occurs in males.Its course is shorter,its signs are more significant,the abnormal metabolism is severer,the hormone level is higher,and the incidence of vascular complications is higher in hypokalemia patients,especially in those with arrhythmia and proteinuria.