特发性醛固酮增多症心肌重构与螺内酯治疗  

Cardiac structural changes in idiopathic hyperaldosteronism and treatment with spironolactone

作　　者：叶菲[1] 汤正义[1] 吴景程[1] 杨洋[1] 田秀丽[1] 黄佳佳[1] 徐茜[1] 张杉杉[1] 李小英[1] 王卫庆[1] 宁光[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科上海市内分泌代谢病临床医学中心,上海200025

出　　处：《第二军医大学学报》2011年第7期697-700,共4页Academic Journal of Second Military Medical University

基　　金：国家杰出青年科学基金(30725037)~~

摘　　要：目的探讨原发性醛固酮增多症(primary aldosteronism,PA)患者心室重构的情况,观察特发性醛固酮增多症(idiopathic hyperaldosteronism,IHA)患者在经过螺内酯治疗后的心肌重构转归,以及这种转归与血压、血醛固酮的关系。方法收集172例PA患者作为实验组,100例原发性高血压(essential hypertension,EH)患者作对照组。收集两组病史资料,比较两组一般临床资料、生化指标、激素水平,以及主动脉根部内径(AO)、左房内径(LAd)、左室舒张末内径(DVLd)、左室收缩末内径(SVLd)、室间隔厚度(IVST)、左室后壁厚度(LVPW)、左室质量指数(LVMI)等心脏超声指标。随访38例IHA患者,观察经螺内酯治疗后的上述心脏超声指标的转归,并对心肌重构相关指标及其转归和血压、醛固酮水平进行相关性分析和线性回归分析。结果 PA组较EH组AO、LAd、DVLd、SVLd、IVST、LVPW、LVMI均增加(P<0.01),与收缩压正相关(P<0.05)。IHA组治疗后心肌肥厚指标如IVST、LVMI改善(P<0.01);心室容量相关指标如AO、LAd、DVLd、SVLd无变化,与醛固酮水平的变化相关(P<0.05)。结论 PA和EH相比表现出更为严重的心室重构,和收缩压的关系更大;螺内酯治疗可改善IHA患者的心室肌厚度。Objective To analyze the cardiac structural changes of patients with primary aldosteronism（PA）,to observe cardiac structural remodeling of idiopathic hyperaldosteronism（IHA） patients after treatment with spironolactone,and to discuss the association of the remodeling with blood pressure and blood aldosterone levels.Methods A total of 172 PA patients were taken as experimental group and 100 patients with essential hypertension（EH） served as control group.The clinical data of patients in the two groups were collected.The general information,biochemical data,hormone levels and echocardiographic parameters,including the aortic opening（AO）,left atrium diameter（LAd）,diastolic left ventricular diameter（DVLd）,systolic left ventricular diameter（SVLd）,interventricular spetal thickness（IVST）,left ventricular posterior wall thickness（LVPW）,and left ventricular mass index（LVMI） were compared between the two groups.Thirty-eight patients with IHA were followed up,and changes of the above-mentioned echocardiographic parameters were observed.We also analyzed the relationship between the parameters of cardiac structural remodeling with the blood pressure and plasma aldosterone levels.Results The AO,LAd,DVLd,SVLd,IVST,LVPW,and LVMI in PA group were significantly increased compared with those in EH group（P0.01）,and these parameters were positively correlated with the systolic pressure（P0.05）.The cardiac hypertrophy parameters,such as IVST and LVMI,were significantly improved after treatment with spironolactone（P0.01）;and the cardiac volume parameters,such as AO,LAd,DVLd,and SVLd,had no noticeable changes,and were correlated with plasma aldoterone level.Conclusion PA patients have a more severe cardiac remodeling compared with EH patients,which has a closer relationship with systolic blood pressure.Treatment with spironolactone can ameliorate the cardiac structural changes,especially the cardiac hypertrophy,in IHA patients.

关 键 词：特发性醛固酮增多症 螺内酯 心室重构 

分 类 号：R586.24[医药卫生—内分泌]