特发性醛固酮增多症与低肾素原发性高血压的关联性

Discussion on the clinical association between idiopathic hyperaldosteronism and low renin essential hypertension

目的探讨特发性醛固酮增多症与低肾素原发性高血压间的关联性。方法比较特发性醛固酮增多症(特醛症)(IHA)与低肾素原发性高血压(LREH)患者临床表现的异同。收集119例高血压患者的临床资料,分为特醛组(IHA组)45例、低肾素原发性高血压组(LREH组)25例、正常肾素原发性高血压组(NREH组)49例,比较3组醛固酮等相关指标的差异。结果 LREH组的肾素活性和醛固酮水平均低于NREH组,而醛固酮/肾素比值明显增高(P<0.05);IHA组血钾水平低于LREH组,而前者醛固酮水平高于后者(P<0.05),盐水负荷及卡托普利试验后醛固酮下降率两组间差异无统计学意义(P>0.05)。将IHA组按醛固酮/肾素比值递增顺序分为3个亚组进行比较,发现随着醛固酮/肾素比值的增高,肾素活性逐渐降低(P<0.05),而醛固酮水平无明显变化(P>0.05)。结论从低肾素原发性高血压到特发性醛固酮增多症,可能是一个肾素-血管紧张素Ⅱ-醛固酮系统调控异常由轻微到逐渐明显的连续性过程。

Objective To compare the clinical characteristics between idiopathic hyperaldosteronism(IHA)and low renin essential hypertension(LREH)and probe into the association between them in depth.Methods We retrospectively analyzed the clinical data of 119 hypertensive patients,including 25 patients with LREH,49 patients of essential hypertension with normal renin(NREH)and 45 patients with IHA according to the 2016 guidelines of management of primary aldosteronism of endocrine association.Results The plasma renin activity(PRA)and plasma aldosterone concentration(PAC)of LREH patients were lower than NREH patients,but still significantly higher aldosterone renin ratio(ARR)(P<0.05).The serum potassium level of IHA patients was lower than that of LREH patients,while the basal PAC and PAC post saline infusion test(SIT)and captopril challenge test(CCT)were significantly higher than LREH patients(P<0.05).Patients of two groups had similar PAC reduction rate post SIT and CCT though(P >0.05).When we made a subgroup comparison of IHA patients based on ARR on ascending order,we found that plasma renin activity gradually decreasing(P<0.05)while PAC remained unchanged(P >0.05).Conclusion The clinical variation from low renin essential hypertension to idiopathic hyperaldosteronism may be a continuous course where disorder of renin-angiotensinⅡ-aldosterone system gradually grows obvious.