原发性醛固酮增多症患者的心血管损害研究  

Cardiac and vascular damage in patients with primary aldosteronism

作　　者：邢玉微[1] 

机构地区：[1]石家庄市第二医院内分泌科,石家庄050051

出　　处：《岭南心血管病杂志》2015年第5期673-676,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨原发性醛固酮增多症(primary aldosteronism,PA)患者左心室肥厚和颈动脉粥样硬化的病因。方法选取确诊的PA患者51例,另择同期诊断的原发性高血压(essential hypertension,EH)患者184例作为对照。两组均行颈动脉及心脏超声检查,测定颈动脉内膜中层厚度(carotid artery intima-media thickness,CIMT)及心脏室间隔厚度(interventricular septal thickness,IVST)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)及左心室舒张末期内径(left ventricular end-diastolic dimension,LVDd),计算左心室质量(left ventricular mass,LVM)和左心室质量指数(left ventricular mass index,LVMI)。比较分析两组上述指标的差异。结果PA组的醛固酮浓度和IVST、LVMI及C-IMT均明显高于EH组,差异有统计学意义(P<0.05);而肾素活性及血钾、三酰甘油、低密度脂蛋白胆固醇浓度明显低于EH组,差异有统计学意义(P<0.05);两组性别构成比、年龄、体质量指数、收缩压、舒张压、LVPWT、颈动脉斑块发生率及血清总胆固醇浓度、高密度脂蛋白胆固醇浓度比较,差异无统计学意义(P>0.05);偏相关性分析表明LVMI(r=0.140,P<0.05)、C-IMT(r=0.181,P<0.05)与醛固酮浓度密切相关;而LVPWT、颈动脉斑块发生率和醛固酮浓度无明显相关性(P>0.05)。结论与EH患者比较,PA患者更容易发生较为严重的心脏和血管并发症,其原因可能和醛固酮损害有关。Objectives To explore the causes of left ventricular hypertrophy and carotid atherosclerosis in patients with primary aldosteronism（PA）. Methods Totally 51 patients with PA and 184 patients with essential hypertension（EH）were included in this study. All the subjects underwent carotid and cardiac ultrasound examination to measure carotid artery intima-media thickness（C-IMT）, interventricular septal thickness（IVST）, left ventricular posterior wall thickness（LVPWT） and left ventricular end-diastolic dimension（LVDd）. Left ventricular mass（LVM） and left ventricular mass index（LVMI） were calculated. Indexes above between the two groups were analyzed and compared.Results Aldosterone concentration, IVST, LVMI and C-IMT in PA group were significantly greater than those in EH group（P〉0.05）; while plasma renin activity, serum concentrations of kalium, trigalloyl glycerol and low-density lipoprotein cholesterol in PA group were significantly lower than those in EH group（P〈0.05）. There were no significant differences in sex constituent ratio, age, body mass index, systolic blood pressure, diastolic blood pressure, LVPWT,incidence of carotid plaque, total cholesterol and high-density lipoprotein cholesterol between PA and EH groups（P〈0.05）. Partial correlation analysis showed that both LVMI（r =0.140, P〉0.05） and C-IMT（r =0.181, P〉0.05） were strongly associated with aldosterone concentration,but no significant correlation were observed among LVPWT,incidence of carotid plaque and aldosterone concentration（P〉0.05）. Conclusions Compared with EH patients, PA patients are more likely to have serious cardiac and vascular complications, and the excess aldosterone may be responsible for them.

关 键 词：原发性醛固酮增多症 左心室肥厚 颈动脉粥样硬化 颈动脉内膜中层厚度 

分 类 号：R586.24[医药卫生—内分泌]