原发性醛固酮增多症与糖代谢紊乱的研究进展

Research progress of primary aldosteronism and glucose metabolism disorder

原发性醛固酮增多症作为内分泌性高血压中最常见的类型伴有相当比例的糖代谢异常,是内分泌性糖尿病的一种病因,可能机制包括自主醛固酮过量分泌并通过盐皮质激素受体及非盐皮质激素受体等导致外周组织和肝脏等胰岛素敏感性下降、胰岛功能受损。近期研究表明,原发性醛固酮增多症合并皮质醇共分泌发生率较高,皮质醇作为一种糖皮质激素,可以通过糖皮质激素受体及盐皮质激素受体发挥作用,促进糖异生、抑制糖原合成、降低胰岛素敏感性及胰岛素分泌等途径影响糖代谢。盐皮质激素受体拮抗剂对糖代谢的影响目前仍存在争议,针对合并皮质醇共分泌且不宜手术的原发性醛固酮增多症患者,盐皮质激素受体拮抗剂联合糖皮质激素受体拮抗剂或许对糖代谢发挥作用。

As the most common type of endocrine hypertension with a considerable proportion of abnormal glucose metabolism,primary aldosteronism is a cause of endocrine diabetes.The possible mechanisms include excessive secretion of autonomic aldosterone,which leads to decreased insulin sensitivity in peripheral tissues and liver,and impaired pancreatic islet function through mineralocorticoid receptor and non mineralocorticoid receptor.Recent studies have shown that primary aldosteronism with co-secretion of cortisol has a high incidence and has received more and more attention.As a glucocorticoid,cortisol can play a role through glucocorticoid receptor and mineralocorticoid receptor,promoting gluconeogenesis,inhibiting glycogen synthesis,reducing insulin sensitivity and insulin secretion to affect glucose metabolism.The effect of mineralocorticoid receptor antagonists on glucose metabolism is still controversial.For patients with primary aldosteronism combined with cortisol co-secretion and unsuitable for surgery,mineralocorticoid receptor antagonists combined with glucocorticoid receptor antagonists may play a dominant role in glucose metabolism.