肾上腺醛固酮腺瘤术后血压影响因素分析

Factors Associated with the Resolution of Hypertension Following Laparoscopic Adrenalectomy in Aldosterone-Producing Adenoma

目的探讨肾上腺醛固酮腺瘤(APA)行腹腔镜下患侧肾上腺切除术后影响血压治愈的相关因素。方法回顾性分析2014年1月—2017年1月106例APA患者的临床资料。根据患者术后血压是否恢复正常分为治愈组(n=70)和非治愈组(n=36)。分析两组患者术后血压随访情况及影响因素。结果术后1个月APA患者血压治愈率为68.9%(73/106),6个月治愈率为66.0%(70/106)。多因素分析显示,年龄(RR=1.418,P=0.033)和术前血浆醛固酮浓度(RR=1.203,P=0.022)是患者术后6个月持续高血压的危险因素。ROC曲线显示,年龄和血浆醛固酮浓度的AUC分别为0.871和0.950,界值分别为44.5岁和121.5 pg/mL。结论术前年龄较低或血浆醛固酮浓度较低的APA患者,术后血压更易控制。

Objective To evaluate the influencing factors associated with the resolution of hypertension after laparoscopic adrenalectomy in patients with aldosterone-producing adenoma(APA).Methods The clinical data of 106 patients with APA from January 2014 to January 2017 were prospectively analyzed.The patients were divided into the resolved group(n=70)and not resolved groups(n=36)according to recovery of the postoperative blood pressure recovered or not.A close follow-up of blood pressure was enforced in all patients,and the influencing factors of the resolution of hypertension were analyzed.Results The rates of resolution of hypertension were 68.9%(73/106)at 1 month and 66.0%(70/106)at 6 months after the operation.Multivariate logistic regression analysis revealed that age(RR=1.352,P=0.027)and serum aldosterone level(RR=1.206,P=0.001)were the independent predictors of the resolution of hypertension.Furthermore,it was suggested that the area under the curve of age and plasma aldosterone concentration were 0.871 and 0.950 according to the ROC,and the cutoff values were 44.5 years and 121.5 pg/mL,respectively.Conclusions The lower age and serum aldosterone before surgery may significantly improve the resolution of hypertension after laparoscopic adrenalectomy in patients with APA.