产生醛固酮的肾上腺瘤术后持续高血压的病因分析  

Factors for postoperative persistent hypertension in patients with aldosterone producing adenoma

作　　者：刘定益[1] 郑崇达[1] 陈其智[1] 张祖豹[1] 吴瑜璇[1] 王瑞伦[1] 凌建煜[1] 胡桑 孙光平 

机构地区：[1]上海第二医科大学瑞金医院泌尿外科

出　　处：《中华外科杂志》1997年第7期437-439,共3页Chinese Journal of Surgery

摘　　要：为了解产生醛固酮的肾上腺腺瘤（ＡＰＡ）术后部分患者持续高血压的病因，作者对５３例产生醛固酮的肾上腺腺瘤术后患者进行了平均３．１年的随访。全部患者术后血钾正常，血压正常者３７例，血压≥１８．７／１２．７ｋＰａ１６例。将正常血压与持续高血压２组患者从性别、年龄、有无高血压史，对安体舒通的降压反应、术前高血压值、高血压时间、血清钾值、２４小时尿醛固酮值、ＰＲＡ值以及手术方式进行比较。结果显示：≥５０岁ＡＰＡ患者发生持续高血压机会与＜４０岁ＡＰＡ患者比值比３∶１；在持续高血压的平均年龄与正常血压平均年龄以及对安体舒通的降压反应之间存在显著差异（Ｐ＜０．０５）。提示年龄愈大的ＡＰＡ患者以及对安体舒通降压反应不明显的患者除了醛固酮增高引起高血压的原因之外，尚有肾内小血管病变或肾间质病变等原因。作者建议对该类患者手术时行肾穿刺活检，以明确病因，有利术后进一步治疗。We determined the factors for postoperative persistent hypertension in the patients with aldosterone producing adrenal adenoma (APA) in 53 patients with APA who were followed up for average 3 1 years. All had normal serum potassium concentration postoperatively.Blood pressure was normal in 37 patients (69 8%) but 18 7/12 7kPa or more in 16 patients (30 2%) with persistent hypertension.Also compared were sex,age, history of hypertension, effect of reducing blood pressure to antisterone, preoperative blood pressure, time of persistent hypertension, serum potassium concentration, aldosterone concentration in 24 hour urine,amount of PRA, and the type of operation.The results showed that an APA patient aged 50 years or more appears to have a great chance of persistent hypertension than an APA patient under age of 40 years, and the odds ratio is 3∶ 1.There was a significant difference between the mean age for persistent hypertension and for normal blood pressure, and varioas response of reducing blood pressure to antisterone( P <0 05). It is suggested that for an older APA patient and the patient without of reducing blood pressure to antisterone, there are other factors for hypertension such as renal veinlet change or renal interstitial lesions except for hyperaldosteronism. We recommend renal biopsy (using kidney puncture) at the operating table for those patients in order to understand pathological change and guide treatment after operation.

关 键 词：醛固酮增多症 高血压 肾上腺肿瘤 手术后 病因 

分 类 号：R736.6[医药卫生—肿瘤] R544.102[医药卫生—临床医学]