原发性醛固酮增多症患者无症状颅内动脉狭窄的危险因素及临床特征

Risk factors and clinical characteristics of asymptomatic intracranial arterial stenosis in patients with primary aldosteronism

目的比较原发性醛固酮增多症(PA)和原发性高血压(EH)患者无症状颅内动脉狭窄(aICAS)的临床特征,分析aICAS的危险因素。方法选择2020年1月至2021年12月连续在上海交通大学医学院附属瑞金医院查因的高血压患者842例,其中PA患者264例,EH患者578例。分别在PA、EH及所有高血压患者中,根据头颅磁共振血管成像(MRA)结果将患者分为无狭窄、颅内动脉粥样硬化(ICA)(颅内动脉狭窄率<50%)及aICAS组(狭窄率≥50%)。比较3组临床特征的差异。采用多因素logistic回归分析aICAS的影响因素。结果PA组aICAS的患病率明显高于EH组(7.6%比3.8%,χ^(2)=5.433,P=0.020)。PA患者中,aICAS及ICA较颅内动脉正常患者的年龄大,高血压病程长,aICAS患者的立位血浆醛固酮水平及诊室收缩压较ICA及颅内动脉正常患者更高(均P<0.05)。多因素logisitic回归分析显示,高血压病程(OR=1.110,95%CI 1.045~1.179,P=0.001)、诊室收缩压(OR=1.035,95%CI 1.011~1.061,P=0.005)、24 h尿醛固酮水平(OR=1.002,95%CI 1.001~1.004,P=0.005)及低密度脂蛋白胆固醇(LDL-C)水平(OR=2.302,95%CI 1.139~4.656,P=0.020)是PA患者aICAS的独立危险因素。结论PA患者有更高的aICAS患病率;PA患者的aICAS与高血压病程长、收缩压升高、高24 h尿醛固酮水平及高LDL-C水平有关。

Objective To compare the clinical features of asymptomatic intracranial arterial stenosis(alCAS)in patients with primary aldosteronism(PA)and essential hypertension(EH)and to analyze the risk factors of aICAS.Methods From January 2020 to December 2021,842 patients who consecutively visited Ruijin Hospital for investigating the cause of hypertension were recruited,including 264 PA and 578 EH patients.Among the patients with PA,EH and all hypertensives,based on intracranial magnetic resonance angiography(MRA)results,patients were respectively divided into three groups:normal,intracranial atherosclerosis(ICA)group(stenosis rate<5o%)and alCAS group(stenosis rate≥50%).The differences of clinical characteristics among the three groups were compared.Multivariate logistic regression was used to analyze the influencing factors of alCAS.Results The prevalence of AICS in PA group was significantly higher than that in EH group(7.6%us 3.8%,χ^(2)=5.433,P=O.020).The PA patients with aICAS and ICA had older age,longer duration of hypertension than normal group,and the patients with alCAS had higher upright plasma aldosterone concentration and higher systolic blood pressure than ICA group and normal group(all P<0.05).Multivariate logisitic regression analysis showed that duration of hypertension(OR=1.110,95%CI 1.045-1.179,P=0.001),systolic blood pressure(OR=1.035,95%CI 1.011-1.061,P=0.005),24 h urinary aldosterone levels(OR=1.002,95%CI 1.001-1.004,P=0.005)and low density lipoprotein cholesterol(LDL-C)(OR=2.302,95%CI 1.139-4.656,P=0.020)were independent risk factors for aICAS in PA patients.Conclusions PA patients have higher prevalence of alCAS.aICAS is associated with the long duration of hypertension,elevated systolic blood pressure,high 24-hour urine aldosterone levels and high LDL-Clevels in PA patients.