新诊断高血压患者中原发性醛固酮增多症患病状况调查  

Investigation of the prevalence of primary aldosteronism among newly diagnosed patients with hypertension

作　　者：杜馥曼[1] 王嵬民[2] 段滨红[1] 王亦薇[1] 胡月飞[3] 

机构地区：[1]黑龙江省医院内分泌科,黑龙江省哈尔滨150036 [2]黑龙江省医院心血管内科,黑龙江省哈尔滨150036 [3]黑龙江省医院院内感染科,黑龙江省哈尔滨150036

出　　处：《中国基层医药》2016年第16期2434-2437,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：黑龙江省卫生和计划生育委员会科研课题（2013363）

摘　　要：目的：观察新诊断高血压患者中原发性醛固酮增多症（PA）的患病率及其临床特点。方法测定255例新确诊高血压患者的血浆肾素活性（PRA）、血管紧张素Ⅱ（ATⅡ）、醛固酮（PAC）、皮质醇（COR）、促肾上腺皮质激素（ACTH）、24 h 尿香草扁桃酸（VMA）水平，检查双侧肾动脉彩色多普勒及肾上腺64排 CT平扫＋增强扫描。结果原发性高血压（EH）患者179例（70．20％），其中低钾血症24例（13．41％）。确诊PA 患者42例（16．47％），其中低钾血症18例（42．86％），单侧肾上腺腺瘤25例（59．52％）。PA 患者高密度脂蛋白（HDL-C）显著高于 EH 患者（Z ＝－2．068，P ＝0．036），总胆固醇（TC）、低密度脂蛋白（LDL-C）、空腹血糖（FPG）、血钾显著低于 EH 患者（Z ＝3．594，P ＝0．000；Z ＝2．807，P ＝0．005；Z ＝3．499，P ＝0．000；Z ＝8．435，P ＝0．000）。PA 患者 PRA、ATⅡ水平均显著低于 EH 患者（Z ＝3．673，P ＝0．000；Z ＝2．215，P ＝0．026），血浆 PAC、醛固酮与肾素活性比值（ARR）均显著高于 EH 患者（Z ＝8．562，P ＝0．000；Z ＝19．871，P ＝0．000）。42例 PA 患者中血浆醛固酮最低值为292．1 pg／L，ARR 最低值为376．7。179例 EH 患者中血浆醛固酮最高值为311．3 pg／L，ARR 最高值为291．2。结论新诊断高血压患者中 PA 检出率较高，单侧肾上腺腺瘤是主要病因，低钾血症不常见，PA 对糖脂代谢影响不大，ARR 用于 PA 与 EH 的鉴别诊断准确率高。Objective To observe the morbidity and clinical characteristics of primary aldosteronism （PA） in newly diagnosed patients with hypertension.Methods 255 patients with newly diagnosed high blood pressure were determined plasma renin activity （PRA）,angiotensinⅡ（ATⅡ）,aldosterone （PAC）,cortisol （COR）,adrenocortico-tropic hormone （ACTH）and 24h urinary vanilmandelic acid （VMA）.They were examined renal artery color doppler and adrenal 64 row CT scan ＋enhancement scanning.Results 179 patients （70.20%）were diagnosed essential hypertension （EH）.In EH patients,24 cases （13.41%）with hypokalemia.42 patients （16.47%）were diagnosed PA.In PA patients,18 cases （42 .86 %）with hypokalemia,25 cases（5 9 .5 2 % ）with unilateral adrenal adenoma. Compared with EH patients,there were higher level of high density lipoprotein （HDL -C）（Z =-2.068,P =0.036）,lower level of total cholesterol （TC）,low density lipoprotein （LDL -C）,fasting plasma glucose （FPG）, serum kalium （Z =3.594,P =0.000;Z =2.807,P =0.005;Z =3.499,P =0.000;Z =8.435,P =0.000）in PA patients.The levels of plasma PRA and ATⅡin PA patients were lower than in EH patients（Z =3.673,P =0.000;Z =2.215,P =0.026）.The levels of plasma PAC and ARR were higher than in EH patients （Z =8.562,P =0.000;Z =19.871,P =0.000）.The minimum value of plasma PAC was 292.1pg/L,the ARR was 376.7 in 42 PA patients. The maximum value of plasma PAC was 311.3pg/L,and the ARR was 291.2.Conclusion There is high detection rate of PA in newly diagnosed hypertension.The unilateral adrenal adenoma is a main cause of PA.Hypokalemia is not common in PA patients.PA has little influence on glucolipid metabolism.ARR has high differential diagnosis accuracy for PA and EH.

关 键 词：醛固酮增多症 高血压 肾素 

分 类 号：R544.1[医药卫生—心血管疾病] R586.24[医药卫生—内科学]