原发性醛固酮增多症87例血脂代谢情况分析

Characteristics of Lipid Metabolism in Patients with Primary Aldosteronism(analysis of 87 cases)

目的分析原发性醛固酮增多症（PA）的临床及血脂代谢特点。方法收集经术后病理证实的PA患者87例,其中肾上腺皮质腺瘤75例,肾上腺皮质增生12例,回顾性分析其临床特征、生化指标、血浆醛固酮（Ald）、肾上腺影像学及疗效情况,并与原发性高血压（EH）患者及血压正常的人群进行对比。结果 （1）PA患者立位和卧位血浆Ald分别为（0.230±0.061）和（0.217±0.065）ng/mL,腺瘤组与增生组间差别无统计学意义（P〉0.05）,且均高于EH组（P〈0.05）。（2）93.1%的PA患者伴有高血压,其中3级高血压占54.0%。（3）62.1%的PA患者表现为高血压伴低血钾,腺瘤组的血钾水平明显低于增生组及EH组[分别为3.19（2.56-3.83）,3.80（3.58-4.27）,4.04（3.75-4.37）mmol/L];腺瘤组的血钠水平明显高于增生组及EH组[分别为（143.34±3.09）,（140.87±2.08）,（142.12±2.22）mmol/L,均为P〈0.05]。（4）腺瘤组的甘油三酯明显低于增生组及EH组[分别为1.10（0.81-1.53）,1.41（1.05-2.44）,1.66（0.98-2.71）mmol/L],极低密度脂蛋白胆固醇（VLDL-C）明显低于余2组[分别为0.50（0.36-0.69）,0.64（0.48-1.11）,0.70（0.44-1.17）mmol/L],高密度脂蛋白胆固醇（HDL-C）水平明显高于余2组[分别为1.35（1.15-1.58）,1.08（0.95-1.32）,1.24（0.97-1.43）mmol/L,均为P〈0.05]。（5）Logistic回归分析提示,高VLDL-C血症（OR=164.688）及高甘油三酯水平（OR=15.740）为肾上腺皮质增生的预测因素;低钾血症（OR=0.103）及高血钠水平（OR=0.653）为肾上腺皮质腺瘤的预测因素（均为P〈0.05）。（6）经腹腔镜肾上腺肿物切除术后血压明显下降[术前后血压分别为（178.29±30.53）/（102.53±16.88）,（133.99±16.36）/（82.60±10.70）mmHg,P〈0.01]。结论肾上腺皮质腺瘤患者更易出现低钾血症,肾上腺皮质增生患者更易出现脂代谢紊乱;手术切除肾上腺肿物可有效降低患者血压。

Objective To analyze the clinical characteristics and profile of lipid metabolism in patients with primary aldosteronism（PA）. Methods The clinical data wereretrospectively collected from87 patients with PA confirmed by postoperative pathologicalexamination,of which 75 were adrenal cortical adenoma and 12 were cortical hyperplasia. Biochemical data,serum aldosterone（Ald）,adrenal imaging and efficacy were recorded,compared with the patients with essential hypertension（EH）and normotensives. Results（1）The levels of Ald in PA patients were（0.23±0.06）ng/mL and（0.21±0.06）ng/mL in upright and supine position respectively,which were higher than those of the patients in EH group significantly（P〈0.05）. Nevertheless,there were no significant difference between the adenoma and hyperplasia group（P〉0.05）.（2）93.1% of PA patients manifested with hypertension,among which 54.0%hypertensive was at level 3.（3）62.1% hypertensive were with hypokalemia. The level of serum potassium was significant lower in adenoma group[3.19（2.56-3.83）mmol/L]than in hyperplasia[3.80（3.58-4.27）mmol/L]and EH ones[4.04（3.75-4.37）mmol/L]（P〈0.05）,while the level of serum sodium in adenoma group[（143.34±3.09）mmol/L]was higher than those in hyperplasia group[（140.87±2.08）mmol/L]and EH group[（142.12±2.22）mmol/L]（P〈0.05）.（4）The levels of triglyceride in adenoma group[1.10（0.81-1.53）mmol/L]were lower than those in hyperplasia and EH groups [1.41（1.05-2.44）and 1.66（0.98-2.71）,P〈0.05],while very-low-density lipoprotein cholesterol（VLDL-C）in adenoma group[0.50（0.36-0.69）mmol/L]were lower than in hyperplasia group[0.64（0.48-1.11）mmol/L]and EH group[0.70（0.44-1.17）mmol/L,P〈0.05]. Meanwhile,the level of high-density lipoprotein cholesterol（HDL-C）in adenoma group[1.35（1.15-1.58）mmol/L]was significantly higherthan those in hyperplasia group[1.08（0.95-1.32）mmol/L]and EH group[1.24（0.97-1.43）mmol/L]（P〈0.05）.（5）Multi-factor Logistic regression analysis showed that high VLDL-C（OR=164.688）,high level of triglyceride（OR=15.740）were the predictors of adrenal cortical hyperplasia. Neverthless,hypokalemia（OR=0.103）and high level of serum sodium（OR=0.653）were the predictor of adrenocortical adenoma（P〈0.05,respectively）.（6）The blood pressure dropped significantly after laparoscopic adrenal neoplasm resection from the baseline of（178.29±30.53）/（102.53±16.88）mmHg to（133.99±16.36）/（82.60±10.70）mmHg（P〈0.01）. Conclusions The patients with adrenal cortical adenoma were prone to be in a condition of hypokalaemia,while the patients with adrenal hyperplasia were susceptible to lipid metabolism disorders. Adrenal neoplasm resection is an effective method in lowering blood pressure in patients with PA.