原发性醛固酮增多症患者药物治疗随访分析  

Follow-up data analysis of primary aldosteronism patients after medication therapy

作　　者：朱理敏[1] 龚艳春[1] 林伯贤[1] 陆晓虹[1] 牛文全[1] 姚利萍[1] 郑芳芳[1] 唐晓峰[1] 陶波[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,上海200025

出　　处：《中华高血压杂志》2013年第6期531-535,共5页Chinese Journal of Hypertension

摘　　要：目的了解非手术治疗的原发性醛固酮增多症(PA)患者经药物治疗后的预后。方法纳入2012-01-05在高血压门诊随访的PA患者186例,依据患者随访时是否使用螺内酯治疗分为螺内酯组和常规药物组。以螺内酯为主的联合药物治疗的患者130例(男性占72%),年龄(51.5±10.5)岁,使用常规药物联合治疗的患者56例(男性占61%),年龄(51.5±8.8)岁。螺内酯组中有肾上腺腺瘤者50例和双侧肾上腺增生者80例。结果两组患者的血压均较治疗前降低,螺内酯组的舒张压低于常规药物治疗组[(84±9)比(88±10)mmHg,P<0.05]。增生者治疗后舒张压低于腺瘤者[(84±9)比(86±10)mmHg,P<0.05]。螺内酯组治疗后的血钾高于同组治疗前和常规药物组治疗后[(4.0±0.4)比(3.4±0.6),(3.8±0.5)mmol/L,均P<0.05]。螺内酯组的基础空腹血糖低于治疗后的空腹血糖[(5.7±1.4)比(6.2±1.5)mmol/L,P<0.05]。两组的临床事件发生率差异无统计学意义。结论未经手术的PA患者经以螺内酯为主的联合药物治疗可以有效降低血压,纠正低血钾,但有升高血糖的趋势。Objective To study the outcome of primary aldosteronism （PA） patients after medication treatments. Methods One hundred and eighty-six PA outpatients followed up at hypertension department from January 2012 to May 2012 were recruited in this study. The patients were divided into spironolactone group（S） and general treatment group （G） based on whether they had taken spironolactone or not during following up. 130 patients （male 72 % ）, age 51.5±10.5 in S group were treated with spironolactone combining with other antihypertensive drugs. 56 patients in G group （male 61% ）, aged 51.5 ± 8.8 were treated with general antihypertensive drugs. According to adrenal CT scan, in S group, there were 50 patients with aldosterone producing adenoma （APA） and 80 patients with bilateral adrenal hyperplasia （BAH）. Results Blood pressure in both groups decreased after the treatments. Diastolic blood pressure was lower in S group than that in G group [（84±9） vs （88±10} mm Hg, P（0.05）. The diastolic blood pressure of BAH patients was lower than that of APA patients [（84±9） vs （86±10） mmHg, P（ 0.05）. The serum potassium level in S group was higher than that at baseline and that of G group after the treatment [（4. 0±0. 4} vs （3.4±0.61, （3.8±0.5} mmol/L, P±0.05]. The after-treatment fasting blood glucose level in S group was higher than at baseline [ （6.2± 1.5） vs （5.7 ± 1.4）mmol/L, P（0.05 ]. There were no signif- icant statistic differences in clinical event occurrences between two groups. Conclusions The spironolactone combination treatment, mainly spironolactone, can reduce blood pressure and correct hypokalemia in PA patients without adrenalectomy. However, this treatment may increase the fasting glucose level.

关 键 词：原发性醛固酮增多症 螺内酯 醛固酮腺瘤 肾上腺增生 

分 类 号：R586.24[医药卫生—内分泌]