多种类型原发性醛固酮增多症患者临床特征及术后随访资料分析

Clinical Features of Patients with Different Types of Primary Aldosteronism and Analysis of Follow- up Data after Operation

目的评价多种类型原发性醛固酮增多症(简称原醛症)患者临床特征及其术后的变化情况。方法纳入1998—2010年在上海中国人民解放军第四一一医院内分泌科诊治的原醛症患者99例,其中醛固酮瘤(APA)57例,特发性醛固酮增多症(IHA)26例,原发性肾上腺增生(PAH)16例。检测血钾、血/尿醛固酮及血浆肾素活性,将所得结果与29例原发性高血压(EH)患者及29例正常对照者进行比较。所有原醛症患者经手术治疗并进行术后随访,所得资料与术前比较。结果 (1)APA、IHA、PAH及EH组收缩压及舒张压均高于对照组,APA、IHA及PAH组血、尿醛固酮均高于EH及对照组,血钾、血浆肾素活性基础及激发值则低于EH及对照组,差异有统计学意义(P<0.05)。(2)APA及PAH患者术后收缩压、舒张压、血/尿醛固酮下降,血钾则升高,与术前比较差异有统计学意义(P<0.05)。IHA患者术后仅血钾较术前有升高,差异有统计学意义(P<0.05),其余各指标无改善,差异无统计学意义(P>0.05)。IHA患者术后收缩压、舒张压、血/尿醛固酮高于APA及PAH患者,血钾则低于APA及PAH患者,差异有统计学意义(P<0.05)。结论原醛症患者可表现为高血压、低血钾、高血/尿醛固酮及血钾肾素活性受抑,APA及PAH患者手术治疗有一定疗效,而IHA患者手术治疗效果不理想。

Objective The purpose of the study was to assess clinical characteristics of patients with different types of primary aldosteronism（PA）and the changes after operation. Methods Ninety - nine patients of primary aldosteronism〔inclu-ding 57 patients with aldosterone - producing ademona（APA）,26 patients with idiopathic hyperaldosteronism（IHA）and 16 patients with primary adrenal hyperplasia（PAH）〕treated in our hospital were involved in the study. Plasma potassium,serum/urinary aldosterone and plasma renin activity（PRA）were measured and the results were compared with those of 29 patients of es-sential hypertension（EH）and 29 in normal control group. All patients of PA were treated with operation and followed up after op-eration and the result was compared with that before operation. Results （1）The systolic and diastolic blood pressure（SBP, DBP）were all higher in APA,IHA,PAH and EH patients than those of control group. The plasma and urinary aldosterone were higher in APA,IHA and PAH patients than those of EH and control groups while the plasma potassium,basal and activated PRA were lower and the differences were significant（P 〈 0. 05）. （2） The SBP,DBP,plasma and urinary aldosterone were de-creased in patients of APA and PAH after operation and the plasma potassium was increased;the differences were statistically sig-nificant from those before operation（P 〈 0. 05）. Only plasma potassium was increased in IHA patients after operation and the difference was significant（P 〈 0. 05）and no improvements were found in other indexes with significant difference（P〉 0. 05）. The SBP,DBP,plasma and urinary aldosterone in IHA patients were higher than those of APA and PAH groups after operation and the plasma potassium was lower with significant difference（P 〈 0. 05）. Conclusion Primary aldosteronism may manifest as high blood pressure,hypokalemia,high plasma and urinary aldosterone,inhibition of plasma renin activity. Operation can have certain curative effects on patients with APA and PAH,but not on patients with IHA.