不同血钾水平原发性醛固酮增多症中医证素及临床特点分析

Analysis of TCM Syndrome Elements and Clinical Characteristics of Primary Aldosteronism with Different Blood Potassium Levels

目的:探讨不同血钾水平原发性醛固酮增多症(PA)患者的中医证素及临床特点。方法:将2017年10月-2021年12月辽宁中医药大学附属医院内分泌科确诊的76例PA患者分为正常血钾组(≥3.5 mmol/L)和低钾血症组(<3.5 mmol/L),并对其中医四诊资料及临床资料进行回顾性分析。结果:本研究共收集PA患者76例,其中男30例,女46例,平均年龄为(55.08±8.52)岁,超重和肥胖患者(体重指数≥23.9 kg/m2)占56.58%;低钾血症组收缩压、尿微量白蛋白/肌酐、卧立位醛固酮较正常血钾组高(P<0.05)。中医病位证素分布依次为肾、肝、脾、心,以肾、肝、脾最为常见。中医病性证素分布依次为气虚、血瘀、痰、阴虚、阳亢、气滞、阳虚、血虚,其中实性病性以血瘀、痰最为常见,二者证素组合占比34.2%。低钾血症组气虚、阳虚、气虚+阳虚证素组合占比均明显高于正常血钾组(P<0.05);正常血钾组阴虚、阳亢+阴虚证素组合占比均明显高于低钾血症组(P<0.05)。临床常见症状依次为眩晕、口渴多饮、胸闷气短、乏力、口苦、心悸、自汗、寐差、便溏、肢体麻木、肢体浮肿、恶心呕吐。低钾血症组乏力、心悸、自汗、肢体麻木症状占比均明显高于正常血钾组(P<0.05);正常血钾组口苦、寐差症状占比均明显高于低钾血症组(P<0.05)。结论:根据不同血钾水平、中医证素及患者临床表现将PA分为阴虚阳亢、气阴两虚及阳气虚衰三期,其中痰、瘀贯穿整个病程。中医治疗应针对不同分期,把握虚实补泻的力度,同时预防心、肾等并发症的出现。

Objective:To explore the TCM syndrome elements and clinical characteristics of patients with primary aldosteronism(PA)with different blood potassium levels.Method:A total of 76 patients with PA who were diagnosed in the Department of Endocrinology,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from October 2017 to December 2021 were divided into normal blood potassium group(≥3.5 mmol/L)and hypokalemia group(<3.5 mmol/L),and the data of the four diagnostic methods in TCM and clinical data were retrospectively analyzed.Result:A total of 76 patients with PA in this study were collected,including 30 males and 46 females,with an average age of(55.08±8.52)years,overweight and obese patients(body mass index≥23.9 kg/m2)accounted for 56.58%.The systolic pressure,microalbuminuria/urine creatinine,clinostatism and standing position aldosterone in hypokalemia group were higher than those in normal blood potassium group(P<0.05).The distribution of syndrome elements of TCM disease location was successively kidney,liver,spleen and heart,with kidney,liver and spleen being the most common.The distribution of syndrome elements of TCM nature of disease was successively qi deficiency,blood stasis,phlegm,yin deficiency,yang hyperactivity,qi stagnation,yang deficiency,and blood deficiency.Among them,blood stasis and phlegm were the most common solid nature of disease,and the combination of the two syndrome elements accounts for 34.2%.The proportions of syndrome elements of qi deficiency,yang deficiency and qi deficiency+yang deficiency in the hypokalemia group were significantly higher than those in the normal blood potassium group(P<0.05).The proportions of syndrome elements of yin deficiency,yang hyperactivity+yin deficiency in the normal blood potassium group were significantly higher than those in the hypokalemia group(P<0.05).The common clinical symptoms were dizziness,thirst and polydipsia,chest tightness and shortness of breath,fatigue,bitter taste,palpitation,spontaneous sweating,poor sleep,loose stool,limb numbness,edema of limbs,nausea and vomiting.The proportion of fatigue,palpitation,spontaneous sweating and limb numbness in the hypokalemia group were significantly higher than those in the normal blood potassium group(P<0.05).The proportions of symptoms of bitter taste and poor sleep in the normal blood potassium group were significantly higher than those in the hypokalemia group(P<0.05).Conclusion:According to different blood potassium levels,TCM syndromes elements and patients'clinical manifestations,PA can be divided into three stages:yin deficiency and yang hyperactivity,qi and yin deficiency and yang deficiency,in which phlegm and blood stasis run through the whole course.TCM treatment should focus on different stages,grasp the strength of reinforcing deficiency and reducing excess,and prevent the occurrence of complications such as heart and kidney.