640例高血压患者中原发性醛固酮增多症患病率及临床特点

Prevalence and Clinical Features of Primary Aldosteronism in 640 Patients with Hypertension

目的探讨高血压患者中原发性醛固酮增多症（PA）的患病率,并分析PA患者的临床特点。方法选择就诊于东莞市中医院内科门诊高血压患者640例,于清晨9∶30~10∶30患者起床2小时后,取坐位5~15 min后采血测定血浆醛固酮（ALD）水平和肾素活性（PRA）,计算血浆醛固酮/血浆肾素活性比值（ARR）。ARR≥30且ALD水平≥15 ng/d L的患者接受开博通试验,服开博通后2小时血浆醛固酮水平抑制程度≤30%,则试验结果为阳性,诊断为原发性醛固酮增多症[1]。进一步分型时,PA患者均进行肾上腺薄层增强CT检查,诊断为特发性醛固酮增多症（IHA）的患者加用盐皮质激素受体拮抗剂（螺内酯）治疗,诊断为醛固酮瘤（APA）患者予以在腹腔镜下行单侧肾上腺切除术。结果 640例患者中112例（17.5%）ARR≥30,其中87例（13.59%）ARR≥30且ALD水平≥15 ng/d L的患者接受开博通试验。服用开博通2 h后血ALD水平抑制≤30%者32例,确诊为PA（5%）,其中20例诊断为APA（3.125%）,另外12例（1.875%）诊断为IHA。诊断为IHA的患者加用螺内酯治疗,醛固酮瘤患者予以在腹腔镜下行单侧肾上腺切除术。结论高血压人群中原发性醛固酮增多症的患病率较高,要重视高血压患者中原发性醛固酮增多症的筛查,原发性醛固酮增多症患者临床具有高血压、低血钾、高尿钾、高醛固酮、低肾素、高ARR的典型临床特点。

Aim To investigate the prevalence of primary aldosteronism（PA）in patients with hypertension and analyse the clinical features of confirmed PA.Methods A total of 640 consecutive outpatients with hypertension were enrolled for screening of PA.Plasma aldosterone（ALD） and plasma renin activity（PRA） were determined at 9 ∶ 30 ~10∶ 00 in the morning after the patients have been up for at least 2h and seated for 5 ~ 15 min.The radio of ALD to PRA（ARR） was calculated.Subjects with ARR ≥30 and ALD≥15 ng/d L received confirmatory Catopirl challenge test.Patients with positive results（plasma aldosterone suppressed≤30%） were dignonsed as PA.An enhancement scan was carried out in all the patients dignosed as PA for further clssification of PA subtype.Results Among 640 patients,112（17.5%）had an elevated ARR（≥30）,and 87（13.59%）had both elevated ARR（≥30）and ALD（≥15 ng/d L）.32（5%）definitely diagnosed as PA by Catopirl challenge test with the levers of ALD were suppressed less than 30% with Catopirl.20（3.125%） patients with APA underwent unilateral laparcoscopic adrenalectory,12（1.875%） patients with IHA were treated with spironolactone.Conclusion The prevalence of PA is higher in the hypertentive population,we should pay attention to hypertensive patients with PA screening.Patients with PA have typical clinical features： hypertension,hypokalemia,high urinary potassium,high aldosterone and low renin,high ARR.