原发性醛固酮增多症患者蛋白尿情况分析  

Proteinuria in patients with primary aldosteronism

作　　者：李南方[1] 马轩[1] 王红梅[1] 李娟[1] 王新国[1] 

机构地区：[1]新疆维吾尔自治区人民医院高血压中心新疆维吾尔自治区高血压研究所,新疆乌鲁木齐830001

出　　处：《中华高血压杂志》2013年第3期249-252,共4页Chinese Journal of Hypertension

基　　金：国家自然科学基金项目(81260129)

摘　　要：目的调查原发性醛固酮增多症(PA)与原发性高血压(EH)患者蛋白尿检出率的差异,并分析PA患者蛋白尿可能的危险因素。方法收集新疆维吾尔自治区人民医院高血压中心2006-01-2010-01因临床特征高度怀疑为PA,且排除睡眠呼吸暂停综合征、嗜铬细胞瘤等其他类型继发性高血压并行24h尿蛋白定量检测的患者401例。患者均经坐位肾素活性及醛固酮测定并计算血浆醛固酮与肾素活性比值(ARR)初筛、盐水负荷试验或卡托普利试验这一诊断流程,最终确诊PA患者155例为PA组,排除PA患者246例为EH组。分析两组尿蛋白、蛋白尿检出率的差异,并采用多元线性回归模型分析PA患者蛋白尿可能的危险因素。结果与EH患者相比,PA患者的24h尿蛋白[(1.99±0.37)比(1.85±0.34)g/24h,P<0.01]、蛋白尿的检出率(14.2%比6.5%,P=0.01)明显增高。进一步用Logistic模型校正年龄、性别及高血压病程后,PA患者蛋白尿检出率仍然高于高血压患者(P=0.031),且PA患者蛋白尿的风险增高(OR2.152)。在PA患者中,校正年龄、高血压病程、血压及血浆肾素活性后,血浆醛固酮是蛋白尿的危险因素(β=0.232,P=0.021)。结论 PA患者尿蛋白及蛋白尿检出率较高,增高的醛固酮是其主要致病因素。Objective To study the proteinuria detection rate in patients with primary aldosteronism （PA} and essential hypertension （EH}, and to explore the possible risk factors for proteinuria in patients with PA. Methods From the hypertension department of People＇s Hospital of Xinjiang Uygur Autonomous Region between January 2006 and January 2010, a total of 401 inpatients were selected, who were highly suspected of PA without sleep apnea syndrome, pheochromocytoma or any other secondary hypertension. All the subjects underwent 24-hour urinary pro- tein quantitative detection, serum aldosterone concentration and plasma renin activity （PRA} detection at the sitting position. The aldosterone-renin ratio （ARR） was calculated as a screening method, and confirmatory tests were including saline load test and captopril challenge test. Finally, 155 patients were diagnosed as PA （PA group}, and other 246 patients who did not meet the criteria for PA were labeled as EH group. The differences in urinary protein level and proteinuria detection rate between the two groups were analysed. The multivariate linear regression model was used to analyze the potential risk factors for proteinuria in PA patients. Results The 24-hour urinary protein level and proteinuria detection rate in PA group were significantly higher than those in EH group [ （1. 995± 0.37） vs {1.85±0. 34）g/24 h, P〈0. 01; 14.2% vs 6.5%, P=0.01]. After the adjustment for age, gender, duration of hypertension by logistic regression model, patients with PA also had higher proteinuria detection rate {P= 0. 031） and higher proteinuria risk （OR 2. 152） compared to patients with EH. The serum aldosterone level was a risk factor for proteinuria in patients with PA （β=0. 232, P=0. 021） after the adjustment for age, blood pressure, duration of hypertension, and PRA. Conclusions The urinary protein level and proteinuria detection rate were higher in patients with PA, and the elevated serum aldosterone level was likely the key pathogenic factor.

关 键 词：原发性醛固酮增多症 蛋白尿 高血压 醛固酮 

分 类 号：R586.24[医药卫生—内分泌]