低血钾与正常血钾原发性醛固酮增多症患者的临床特征  

The comparison of clinical features between hypokalemic and normokalemic primary aldosteronism patients

作　　者：朱理敏[1] 龚艳春[1] 陈绍行[1] 唐晓峰[1] 陶波[1] 陆晓虹[1] 林伯贤[1] 牛文全[1] 初少莉[1] 高平进[1] 朱鼎良[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院高血压科,上海市高血压研究所,200025

出　　处：《中华高血压杂志》2011年第1期43-46,共4页Chinese Journal of Hypertension

摘　　要：背景随着血浆醛固酮与肾素活性比值被普遍用于原发性醛固酮增多症(原醛)的筛查,原醛的确诊率较以往明显提高,更多的正常血钾原醛患者被检出。目的了解正常血钾与低血钾原醛患者临床特征的差异。方法回顾性分析2005-2010确诊的住院原醛患者,以血钾3.5mmol/L为分割点,分为正常血钾组和低血钾组,比较两组患者临床生化、合并症及肾上腺CT影像等差异。结果共有300例低血钾和108例正常血钾原醛患者纳入分析。两组患者在年龄、高血压病程、基础血压等方面无明显差异,正常血钾组患者的血、尿醛固酮水平明显低于低血钾组[分别为(179±94)比(279±181)ng/L,(9.6±7.0)比(17.7±14.5)μg/24h,均P<0.01]。两组患者在糖脂代谢异常、靶器官损害及心脑血管病事件患病率上无明显差异。肾上腺CT扫描显示低血钾组中腺瘤表现者比例高(48.1%比32.1%),正常血钾组中皮质增生比例高(61.3%比47.1%),两组肾上腺病变分布差异有统计学意义(P<0.05)。结论正常血钾原醛与低血钾原醛患者比较,临床表现及并发症无明显差别,但肾上腺皮质增生较为常见。Background With the increasing use of plasma aldosterone to renin ratio to screen primary aldosteronism（PA）,the prevalence of PA increases as well as more normokalemic PA patients are identified.Objective To compare the clinical features between hypokalemic and normokalemic patients with PA.Methods PA patients diagnosed between 2005 and 2010 were retrospectively analyzed.Patients were stratified into hypokalemic group or normokalemic group according to the potassium level less or more than 3.5 mmol/L.The biochemistry data,comorbidities and adrenal CT image were compared.Results Three hundred hypokalemic and 108 normokalemic PA patients were recruited for the analysis.The normokalemic group had lower level of plasma and urinary aldosterone than the hypokalemic group [（179±94）vs（279±181）ng/L,（9.6±7.0）vs（17.7±14.5）μg/24 h,both P〈0.01].There was no significant differences of age,hypertension duration and blood pressure between two groups.Neither the prevalence of glucose and lipid abnormalities nor the cardiac and cerebrovascular comorbidities were significantly different between two groups.The adrenal CT scan showed that adenoma was the dominant cause in hypokalemic group（48.1% vs 32.1%）,while adrenal hyperplasia was the main cause in the normakalemic group（61.3% vs 47.1%）.Conclusion There was no significant difference in clinical features and comorbidities between normakalemic and hypokalemic PA patients,however,more normokalemic patients present bilateral adrenal hyperplasia on CT scan.

关 键 词：原发性醛固酮增多症 低血钾 正常血钾 

分 类 号：R586.24[医药卫生—内分泌]