以急性缺血性脑卒中为首发症状的高血压患者中原发性醛固酮增多症的筛查结果分析

Analysis of screening results of primary aldosteronism in hypertensive patients with acute ischemic stroke as the first symptom

目的了解浙江玉环地区以急性缺血性脑卒中为首发症状的高血压患者中原发性醛固酮增多症(PA)的患病情况,分析其临床特点。方法选取2018年1月至2022年12月玉环市第二人民医院住院部收治的150例以急性缺血性脑卒中为首发症状的高血压患者进行PA筛查,于清晨8:00~10:00行非卧位醛固酮及肾素活性检测,计算醛固酮肾素比值(ARR),ARR阳性患者给予盐水负荷试验,盐水负荷试验阳性者确诊PA,PA患者行肾上腺CT扫描评估肾上腺形态。结果150例患者中共筛查出PA患者23例(15.33%),PA中合并低钾血症8例(34.78%),CT提示肾上腺腺瘤4例(17.39%),双侧肾上腺增生13例(56.52%),单侧肾上腺增生5例(21.74%),而1例(4.35%)患者肾上腺CT无明显病变。PA中3级高血压20例(86.96%),2级高血压3例(13.04%)。结论浙江玉环地区以急性缺血性脑卒中为首发症状的高血压患者中PA的患病率为15.33%,PA中3级高血压比例高达86.96%,低钾血症的比例仅为34.78%,肾上腺影像学中腺瘤、双侧肾上腺增生、单侧肾上腺增生的比例分别为39.13%、34.78%、21.74%。

Objective To investigate the incidence of primary aldosteronism(PA)in hypertensive patients with acute ischemic stroke as the first symptom in Yuhuan,Zhejiang Province,and to analyze its clinical characteristics.Methods A total of 150 hypertensive patients with acute ischemic stroke as the first symptom admitted to the Inpatient Department of the Second People's Hospital of Yuhuan from January 2018 to December 2022 were selected for PA screening.Non-recumbent position aldosterone and renin activities were detected from 8:00 to 10:00 in the morning,and aldosterone renin ratio(ARR)was calculated.Patients with positive ARR were given saline load test,and patients positive in saline load test was confirmed as PA.Adrenal morphology was evaluated by CT scan in patients with PA.Results Among the 150 patients,23(15.33%)were diagnosed with PA,8(34.78%)were combined with hypokalemia,4(17.39%)were diagnosed with adrenal adenoma by CT,13(56.52%)were diagnosed with bilateral adrenal hyperplasia,and 5(21.74%)were diagnosed with unilateral adrenal hyperplasia.There was no obvious adrenal CT lesion in 1 patient(4.35%).There were 20 patients(86.96%)with grade 3 hypertension and 3 patients(13.04%)with grade 2 hypertension in PA.Conclusion In Yuhuan area of Zhejiang Province,the prevalence rate of PA among hypertensive patients with acute ischemic stroke as the first symptom was 15.33%,the proportion of grade 3 hypertension in patients with PA was as high as 86.96%,and the proportion of hypokalemia was only 34.78%.The proportions of adenoma,bilateral adrenal hyperplasia and unilateral adrenal hyperplasia were 39.13%,34.78%,and 21.74%,respectively.