原发性醛固酮增多症46例临床分析

The clinical features analysis of 46 patients with primary aldosteronism

目的：探讨原发性醛固酮增多症（PA）患者的临床特点。方法对46例 PA 患者的临床特点、治疗及预后进行分析。结果（1）患者年龄30～70岁，高血压分级：1级3例（6．5％），2级12例（26．1％），3级30例（65．2％），血压正常1例（2．2％）。（2）临床诊断腺瘤36例（78．3％），增生5例（10．8％），腺癌1例（2．2％），其他4例（8．7％）；经手术证实20例，18例为单侧腺瘤，1例为癌，1例为右侧结节样增生。（3）低钾26例（56．5％），正常20例（43．5％），平均血钾（3．2±0．9）mmol/L。手术治疗20例，保守治疗26例。手术后血压恢复正常10例，血压无变化1例，降压药物减少9例；低钾患者11例行手术治疗，术后10例血钾恢复正常，1例患者血钾上升但仍较正常低下。结论PA 患者高血压以2、3级水平居多，低钾可能为 PA 的晚期症状，也可能是首发症状。心血管疾病为主要的并发症。腺瘤患者手术治疗效果好。

Objective To investigate the clinical features of primary aldosteronism （PA）.Methods Clinical fea-tures, treatment and prognosis of 46 patients with PA were analyzed.Results （1） In patients aged 30 to 70 years, high blood pressure classification： grade 1 of 3 patients （6.5%）, grade two of 12 cases （26.1%）, grade 3 of 30 cases （65.2%）, blood pressure normal of one case （2.2%）.（2） Adenoma of 36 cases （78.3%）, hyperplasia of five cases （10.8%）, ade-nocarcinoma of 1 case （2.2%）, the other of four cases （8.7%）; confirmed by surgery in 20 cases, 18 cases were unilateral adenoma, one case of cancer, one case was the right of nodular hyperplasia .（3）Hypokalemia in 26 cases （56.5%）, normal in 20 patients （43.5%）, mean serum potassium （3.2 ＆#177;0.9） mmol /L.Surgical treatment of 20 cases, 26 cases of conser-vative treatment, blood pressure returned to normal after surgery in 10 cases, one case of no change in blood pressure , antihy-pertensive drugs to reduce the blood pressure in nine cases .Hypokalemia in 11 patients underwent surgical treatment , 10 ca-ses of postoperative serum potassium returned to normal , one patients were compared with preoperative serum potassium rising but still low.Conclusion The majority PA patients with high blood pressure are level 2 and 3, the main complications are cardiovascular diseases, the effect of surgery is good for the PA patients with adenoma .