肾上腺占位病变与高血压及低血钾关系的临床研究

The clinical research to relation of Adrenal occupied pathological changes with hypertension and hypokalaemia

目的:探讨肾上腺占位病变与高血压及低血钾的关系。方法:回顾性分析75例肾上腺占位的住院患者病历,将其分为无高血压及低血钾组(0组)、单纯高血压组(1组)和高血压合并低血钾组(2组),对三组的病理结果、病变性质以及血钾、尿钾、立卧位肾素、醛固酮水平和晨8点皮质醇、促肾上腺皮质激素(ACTH)水平进行统计分析。结果:1组发生皮质腺瘤、肾上腺结节样增生及嗜铬细胞瘤几率较高,其病变多具有内分泌功能,以原发性醛固酮增多症及嗜铬细胞瘤最为多见;其次为2组,其出现库欣综合症比例较高,0组发生肿瘤几率较高,其病变多无内分泌功能。三组间的立位肾素水平均有显著统计学差异,以2组肾素水平最低,且与其他两组的血钾水平和醛固酮/肾素比值(ARR比值)均有差异,其血钾水平最低,比值最高;三组间的尿钾、卧位肾素、立卧位醛固酮、皮质醇及ACTH水平差异无统计学意义,高血压分级后各级间的以上指标均差异无统计学意义。结论:肾上腺占位伴有高血压或同时合并低血钾时病变多具有内分泌功能,且立位肾素水平明显降低,其内分泌功能与高血压水平无关;不伴有高血压及低血钾时发生无功能腺瘤可能性较大,病变多无内分泌功能,需注意发生恶性肿瘤的可能。对于肾上腺占位病变,内分泌功能的检测为外科手术治疗提供了有效依据。

Objective： To explore the relation of Adrenal occupied pathological changes with hypertension and hy- pekalaemia. Methods： to retrospective analysis 75 Hospitalization patients case history of Adrenal occupied pathological changes,and divide them to none-hypertension and hypokalaemia group （zero group） , simple hypertension group （one group） ,hypertension combing with hypokalaemia group（ two group） , then to proceed statistical analysis to pathology re- suit,pathological changes character and blood kalium, urine potassium,renirt and aldosterone level of erect and decubitus position and corticosteroid,Adrenocorticotropic Hormone at 8：00 ill the morning of three groups. Results：the occurrence probability of adenomas,adrenal tubercle hyperplasia and pheochromocvtoma in one group is higher, their pathological chan- ges much possess endocrine function, primary alsteronism and pheochromocytor,,la is the most, next the two group, Cushing syndrome proportion ol it is more the tumor probability of the zero group is more, and their i^thoiogical changes much has no endocrine function. There is significant statistics difference with rennin level （ff erect position among three groups, the rennin level of two group is the lowest ,morever,there is statistics difference with the bh^i ka^ium level m^d the ratio of al- dosterone and rennin between it and other two groups,its blood kalium level is the !owest;There is no statistics diffment-e with the urine potassium,renin o~： decubitus position,aldosterone of erect and decubitus pesition,cortieosteroid and Adreno- corficotrot ic Hormone level between tiered＇, groups. All of them have no statistics difference with the targe~ a}~ove among the different levels after among classification of hypertension. Conclusions： Adrenal occupied pathological chang much possess endocrine function when they accompany with hypertension or combing with hypokalaemia meanwhile,furthermore their ren- nin level decrease obviously, their endocrine function have nothing with hypertension; The possibility of occurrencing non- function adenoma is comparatively large when they is noncomitance with hypertension or combing with hypokalaemia,their pathological changes much has no endocrine function, but need caution the possibility of malignant tumor. With regard to Adrenal occupied pathological changes, the detection of endocrine function will provid effect accordance to surgery therapy.