单侧原发性醛固酮增多症术后高血压治愈影响因素分析

Factors influencing complete hypertension cure after adrenalectomy for unilateral primary aldosteronism

目的探讨单侧原发性醛固酮增多症(原醛)患者术后影响高血压治愈的相关因素。方法分析2018年1月至2021年2月郑州大学第一附属医院收治的单侧原醛69例患者的临床资料,所有患者均经肾上腺静脉采血明确诊断后行腹腔镜手术,56例行腹腔镜下肾上腺全切术,13例行腹腔镜下肾上腺部分切除术。随访患者术后血压变化,随访时间6个月至39个月,根据患者血压情况,分为治愈组(27例)和非治愈组(42例),对可能影响血压治愈因素行单因素分析,筛选具有统计学意义指标后行Logistic回归分析影响血压治愈独立因素。结果最终纳入69例原醛患者中;治愈组和非治愈组在年龄、性别、体重指数(BMI)、动态收缩压、动态舒张压、降压药剂量积分、高血压病程等方面差异有统计学意义(F=7.105、χ2=8.472、F=6.980、F=9.819、F=4.238、F=16.160、Z=-2.197,P<0.05);多因素Logistic回归分析显示患者年龄越低[优势比(OR)=0.89,95%可信区间(CI)为0.81~0.99,Waldχ2=4.899,P<0.05],术后高血压治愈可能性越高;术前降压药物剂量积分越低(OR=0.11,95%CI为0.02~0.86,Waldχ2=4.468,P<0.05),术后高血压治愈可能性越高;肾上腺全切患者高血压治愈概率较肾上腺部分切的更高(OR=0.10,95%CI为0.01~0.85,Waldχ2=4.440,P<0.05),差异均有统计学意义。结论单侧原醛患者早期准确诊断并及时治疗有助于提高术后高血压治愈;肾上腺全切手术方式较肾上腺部分切手术更利于单侧原醛高血压治愈。

Objective To investigate the predicators of complete hypertension cure outcomes of adrenalectomy in patients with unilateral primary aldosteronism(PA).Methods The clinical data of 69 patients with primary aldosteronism treated in the First Affiliated Hospital of Zhengzhou University from January 2018 to February 2021 were analyzed retrospectively.All the included patients underwent laparoscopic surgery after diagnosis by adrenal venous sampling,including 56 cases of laparoscopic total adrenalectomy and 13 cases of laparoscopic partial adrenalectom.Patients were followed up for postoperative blood pressure changes from 6 months to 39 months.The patients were divided into cured group(27 cases)and non-cured group(42 cases)according to the blood pressure levels.Factors which would be likely to influence prognosis were collected and screened,follewed by Logistic analysis to assess the independent factors related to outcome of these patients.Results A total of 69 patients were included in the final analysis.Age,sex(male/female),body mass index(BMI),dynamic systolic blood pressure,dynamic diastolic blood pressure,antihypertensive drug dose score,and duration of hypertension were associated with hypertension outcomes in univariate analysis.However,multivariate Logistic regression analysis showed that the younger the patient was[odds ratio(OR)=0.89,95%confidence interval(CI)0.81-0.99,Waldχ2=4.899,P<0.05],the higher the possibility of postoperative hypertension cure.The lower the preoperative antihypertensive drug dose score(OR=0.11,95%CI 0.02-0.86,Waldχ2=4.468,P<0.05),the higher the possibility of postoperative hypertension cure.Total adrenalectomy was more likely to cure hypertension than partial adrenalectomy(OR=0.10,95%CI 0.01-0.85,Waldχ2=4.440,P<0.05).Conclusion Early accurate diagnosis and timely treatment of unilateral PA patients can improve postoperative hypertension cure.Total adrenalectomy may be better than partial adrenalectomy for unilateral PA patients in the treatment of hypertension.