原发性醛固酮增多症患者与左心室肥厚  

Left Ventricular Hypertrophy in Patients with Primary Aldosteronism

作　　者：洪维[1] 龚艳春[1] 初少莉[1] 陈绍行[1] 郭冀珍[1] 朱鼎良[1] 

机构地区：[1]上海市瑞金医院高血压科,上海200025

出　　处：《中华高血压杂志》2008年第2期112-116,共5页Chinese Journal of Hypertension

基　　金：上海市卫生局课题(编号:2006041)

摘　　要：目的探讨原发性醛固酮增多症(原醛)及其主要亚型:腺瘤型和增生型的左室肥厚情况。方法入选确诊原醛患者250例。其中142例行分侧肾上腺静脉取血,分为原醛腺瘤组68例,原醛增生组74例,选取同期年龄、性别、24小时平均血压相匹配的原发性高血压(EH)患者246例作为对照,所有入选者记录一般临床资料和生化指标,并行超声心动图检查。结果1)左室舒张末期内径原醛组[(49.6±4.3)mm]高于EH组[(48.3±4.2) mm,P<0.05],原醛组左室后壁厚度[原醛组(10.5±2.2)mm vs EH组(9.9±1.1)mm]、左室质量(LVM)[原醛组(232.2±75.1)g vs EH组(207.5±46.6)g]、左室质量指数(LVMI)[原醛组(131.9±37.4)g/m^2 vs EH组(118.3±23.7)g/m^2]显著高于EH组(P均<0.01)。2)在原醛组中LVMI与收缩压及立位血浆醛固酮独立相关。3)1级高血压中原醛组的LVMI高于EH组,但差异无统计学意义(P>0.05);2级、3级高血压中,原醛组的LVMI高于EH组(P<0.05或P<0.01)。4)左室后壁厚度[原醛组(10.8±3.0)g vs EH组(10.3±1.3)g,P<0.05];、LVM [原醛组(249.5±81.7)g vs EH组(219.4±67.7)g,P<0.01]、LVMI[原醛组(139.9±41.0)g/m^2 vs EH组(125.1±32.9),P<0.01]原醛腺瘤组显著高于原醛增生组。5)左室肥厚在EH组、原醛腺瘤组和增生组的构成比分别为42.7%,63.2%和43.2%,3组之间差异有统计学意义(P=0.009)。结论原醛患者左室肥厚的发病率高于EH患者,其中以原醛腺瘤组更为严重。Objective To analysis the parameters of left ventricular hypertrophy （LVH） in patients with primary aldosteronism （PA）. Methods Two hundred fifty patients were diagnosed as primary aldosteronsim in this study. One hundred fouty two PA patients undergone the adrenal venous sampling（AVS）. Adenomas （APA） were diagnosed in 68 patients and idiopathic hyperaldosteronism （IHA） in 74 patients. During the same period, clinical characteristics and cardiovascular events of this group were compared with those of 246 patients with essential hypertension （EHT） randomly matched for age, gender, and systolic and diastolic blood pressure. Echocardiographic examinations and biochemical and hormonal assays were conducted in all subjects. Results 1） Left ventricular end-diastolic dimension （LVEDd） was increased in PA patients compared with values in EHT patients（ PA：49.6±4.3 vs EHT：48. 3±4. 2 mm, P〈0. 05） ; PA patients had significant greater left ventricular posterior wall thickness （PWd） （PA：10.5±2.2 vs EHT： 9.9±1.1 mm, P〈0. 01）, left ventricular mass （LVM） （PA：232±75.1 vs EHT：207. 5±46. 6 g, P〈0. 01）, left ventricular mass index（LVMI） （ PA： 131.9 ± 37. 4 vs EHT： 118. 3 ±23.7 g/m^2 , P〈0.01）compared with EHT patients. 2）Multiple regression analysis showed a correlation between LVMI and systolic blood pressure and upright plasma aldosterone in PA. 3）In grade 1 hypertension, there is no difference between the LVMI in patients with PA and that with EHT （P〉0. 051 ; however, in grade 2 and 3 hypertension, the LVMI in patients with PA was increased compared with values in patients with EHT（P〈0. 05 or P〈0. 01）. 4） APA patients had significant greater PWd（APA：10.8±3. 0 vs IHA：10. 3±1.3 mm, P〈0. 051, LVM（APA：249.5±81.7 vs IHA：219.4±67.7 g, P〈0.011, LVMI（APA：139.9±41.0 vs IHA：125.1±33.0 g/m^2, P〈0.011 compared with IHA patients. 51 There was significant difference in the prevalence of left ventricular hyp

关 键 词：原发性醛固酮增多症 左室肥厚 左室质量 左室质量指数 

分 类 号：R586.24[医药卫生—内分泌] R544.1[医药卫生—内科学]