原发性醛固酮增多症手术患者预后影响因素分析

Prognosis factors of patients with primary aldosteronism after adrenalectomy

目的分析原发性醛固酮增多症（pfimary aldosteronism，PA）患者术后血压恢复的影响因素。方法对2009年1月至2012年3月厦门大学附属第一医院泌尿中心收治的PA手术治疗患者进行回顾性研究及临床随访6个月～3年，将可能影响预后的因素进行单因素方差分析，初步筛选其中有统计学意义的指标，进一步采用logistic回归分析影响血压恢复的独立因素。结果93例PA术后患者中，根据影像及病理结果示：醛固酮腺瘤59例（63．44％），单侧肾上腺增生27例（29．03％），特发性醛固酮增多症7例（7．52％）；术后血压恢复正常43例（46．24％），血压部分缓解47例（50．54％），血压无缓解3例（3．22％）；采用logistic回归分析得出3个显著影响因素：高血压病史、术前降压药物控制血压情况、术前血浆醛固酮／肾素活性比值（aldosterone-to-renin ratio，ARR）。结论对于需手术的PA患者可根据其高血压病史、药物疗效及血浆ARR预判术后血压恢复情况，并加强术后随访及生活干预，提高综合治疗。

Objective To investigate the influential factors for recovery of blood pressure in patients with primary aldosteronism （PA）after adrenalectomy. Methods The clinical and follow up data（6-36 months）of patients with PA ,who underwent adrenalectomy between Jan. 2009 and Mar. 2012 were analyzed retrospectively. Factors which would be likely to influence prognosis were collected, and those which showed statistical significance by One-Way ANOVA analysis were screened, followed by further logistic regression analysis to obtain the independent factors related to outcome of these patients. Results Among the 93 PA patients after adrenalectomy, according to the imaging study and pathology results,59 patients were with adrenocortical adenomas （63.44%） ,27 patients with unilateral adrenal hyperplasia （29.03%） , and 7 patients with idiopathic hyperplasia （7.52%）. 43 patients （46. 24% ）returned to normal blood pressure after surgery, 47 patients （50. 54% ）had blood pressure relief, and 3 patients （3.22%）had no improvement of blood pressure. Logistic regression analysis showed the influential factors were as following：history of hypertension, grade of hypertension after receiving medical treatment, and aldosterone renin ratio before surgery. Conclusions Recovery of blood pressure can be evaluated based on hypertension history, hypertension grade after receiving medical treatment, and aldosterone-to-renin ratio for patients needing adrenalectomy. In addition, the follow-up and life style intervention should be strengthened, and comprehensive treatment should be improved.