基因多态性与醛固酮瘤术后持续性高血压的多因素分析

Logistic regression analysis of correlation between gene polymorphism and postoperative persistent hypertension in patients with aldosterone-producing adenoma

目的：探讨CYP11B2和CYP11B1基因多态性及其他因素与醛固酮瘤术后持续性高血压的相关性。方法：提取81例肾上腺醛固酮瘤患者外周血DNA,采用TaqMan探针技术及两对独立PCR反应检测基因多态性位点;收集患者临床资料及随访信息,分析比较术后血压恢复组与未恢复组的数据,用logistic回归分析影响醛固酮瘤术后血压恢复不佳的危险因素。结果：61.7%患者术后血压恢复正常,38.3%患者术后仍有持续性高血压。CYP11B2和CYP11B1基因多态性在血压恢复组与未恢复组的分布差异无统计学意义。血压恢复组患者较未恢复组年龄小,体重指数低,高血压病程短,术前使用降压药数量少,术前对螺内酯治疗更敏感。多元logistic回归分析显示术前控制血压用药量≥2种（OR 6.65,95%CI 1.43-30.81,P=0.016）、术前对螺内酯治疗不敏感（OR 4.39,95%CI 1.34-14.29,P=0.015）是术后血压恢复不佳的独立危险因素。结论：CYP11B2和CYP11B1基因多态性与醛固酮瘤术后血压恢复无相关性;术前对螺内酯治疗不敏感和术前降压药用量≥2种是醛固酮瘤术后血压恢复不佳的独立危险因素,对临床判断预后提供了一定的依据,及早诊断和治疗可以使醛固酮瘤患者有更大益处。

Objective：To investigate the correlation between gene polymorphism in CYP11B2 and CYP11B1or other factors and postoperative persistent hypertension in patients with aldosterone-producing adenoma（APA）.Method：Peripheral blood DNA was extracted from 81 APA patients.TaqMan probes and two seperate PCRs were used for genotyping seven polymorphism sites of the CYP11B2 and CYP11B1genes.Clinical data and follow-up information of APA patients were collected and analyzed.Logistic regression model was performed to analyse the risk factors of postoperative hypertension in APA patients.Result：Blood pressure returned to normal in 61.7%patients,while 38.3% patients still had persistent hypertension.The genotype frequency of polymorphism sites between the recovery group and persistent hypertension group didn＇t show statistically significant differences.Compared with persistent hypertension group,the recovery group had younger age,lower body mass index,shorter duration of hypertension,less amount of preoperative antihypertensive drugs,more sensitive response to spironolactone.Multivariate regression analysis showed that number of preoperative antihypertensive drugs ≥ 2（OR 6.65,95% CI 1.43-30.81,P=0.016）and preoperative ineffective of spironolactone（OR 4.39,95% CI 1.34-14.29,P=0.015）were independent risk factors of postoperative persistent hypertension.Conclusion：Gene polymorphism in CYP11B2 and CYP11B1may not be associated with postoperative hypertension in APA patients.Preoperative ineffective of spironolactone and more than two preoperative antihypertensive drugs used were independent risk factors of postoperative persistent hypertension,which could help to predict the prognosis of APA.Patients can benefit greatly from earlier diagnosis and therapy.