原发性醛固酮增多症高血压患者临床特征分析  

Analysis of Clinical Features of Hypertensive Patients With Primary Aldosteronism

作　　者：刘小宁[1] 蔡军[1] 马文君[1] 周宪梁[1] 宋雷[1] 张慧敏[1] 吴海英[1] 娄莹[1] 郝素芳[1] 卞瑾[1] 张雪[2] 刁晓林 徐心仪 LIU Xiao-ning;CAI Jun;MA Wen-jun;ZHOU Xian-liang;SONG Lei;ZHANG Hui-min;WU Hai-ying;LOU Ying;HAO Su-fang;BIAN Jin;ZHANG Xue;DIAO Xiao-lin;XU Xin-yi(Department of Hypertention,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing（100037）,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院高血压中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院信息中心,北京市100037

出　　处：《中国循环杂志》2018年第9期836-841,共6页Chinese Circulation Journal

基　　金：中央高校基本科研业务费专项资金资助(2018-XHQN11)

摘　　要：目的:分析近两年中国医学科学院阜外医院确诊为原发性醛固酮增多症(PA)的高血压患者的临床特征。方法:回顾性收集2016-01至2017-12期间中国医学科学院阜外医院高血压病房收治的4 782例高血压患者资料,将其中的PA患者与原发性高血压(PH)患者根据年龄、性别1:2匹配后比较其临床特征,并比较血钾正常和低钾血症(<3.5 mmol/L)PA患者的临床特征。结果:247例(5.2%)患者确诊为PA,其中位年龄48.8(16.6)岁,男性148例(59.9%),143例(57.9%)有低钾血症。与PH患者相比,PA患者收缩压较高[150(24)mm Hg vs 145(27)mm Hg,1 mm Hg=0.133 k Pa],左心室质量指数(LVMI)较高[83.4(36.6)g/m^2 vs 75.7(26.2)g/m^2],尿微量白蛋白/肌酐较高[24.1(41.1)mg/g vs 10.5(22.1)mg/g],合并冠心病(12.6%vs 7.7%)和外周动脉疾病(11.7%vs 4.7%)者比例较高,但低密度脂蛋白胆固醇[2.6(1.0)mmol/L vs 2.9(1.1)mmol/L]、总胆固醇[4.4(1.2)mmol/L vs 4.6(1.3)mmol/L]和糖化血红蛋白水平[5.4(0.6)%vs 5.6(0.6)%]较低,差异均有统计学意义(P均<0.05)。与血钾正常的PA患者相比,低钾血症PA患者年龄较小[45.9(16.8)岁vs51.3(14.3)岁],但舒张压[95(26)mm Hg vs 90(20)mm Hg]、尿微量白蛋白/肌酐[28.5(40.6)mg/g vs 20.5(32.8)mg/g]和LVMI [86.5(34.8)g/m2 vs 77.9(31.8)g/m^2]较高,差异均有统计学意义(P均<0.05)。结论:与PH患者相比,PA患者靶器官损害重,合并心血管病比例高。有低钾血症的PA患者年龄较小,但舒张压较高且靶器官损害较重。Objectives： To analyze the clinical features of hypertensive patients with primary aldosteronism（PA） diagnosed in Fuwai Hospital in recent two years. Methods： From January 2016 to December 2017, 4 782 patients with hypertension were admitted to the hypertension department of Fuwai Hospital. Patients with PA were matched 1：2 with patients with primary hypertension（PH） according to age and sex to make comparisons, and patients with PA were divided into two groups according to with or without hypokalemia（ 3.5 mmol/L） to make comparisons. Results： 247（5.2%） patients were diagnosed with PA. The median age of PA patients was 48.8（16.6） years old, of whom 148（59.9%） were male and 143（57.9%） had hypokalemia. Systolic blood pressure（150[24] mm Hg vs 145[27] mm Hg）, left ventricular mass index（LVMI）（83.4[36.6] g/m2 vs 75.7[26.2] g/m2）, urinary albumin-creatinin ration（24.1[41.1] mg/g vs 10.5[22.1] mg/g）, incidence of coronary heart disease（12.6% vs 7.7%） and peripheral artery disease（11.7% vs 4.7%） in PA patients were significantly greater than those in PH patients（all P〈0.05）; while LDL cholesterol（2.6[1.0] mmol/L vs 2.9[1.1] mmol/L）, total cholesterol（4.4[1.2] mmol/L vs 4.6[1.3] mmol/L）and glycosylated hemoglobin（5.4[0.6] % vs 5.6[0.6] %） inPA patients were significantly lower than those in PH patients（all P〈0.05）. Compared with PA patients without hypokalemia, PA patients with hypokalemia had higher diastolic blood pressure（95[26] mm Hg vs 90[20] mm Hg）, urinary albumin-creatinin ration（28.5[40.6] mg/g vs 20.5[32.8] mg/g） and LVMI（86.5[34.8] g/m^2 vs 77.9[31.8] g/m^2） although they were younger（45.9[16.8] years old vs 51.3[14.3] years old）, all P〈0.05. Conclusions： Compared with PH patients, PA patients had heavier target organ damage and higher incidence of cardiovascular disease. PA patients with hypokalemia were younger, but they had higher diastolic blood pressure and heavier target organ damage.

关 键 词：原发性醛固酮增多症 靶器官损害 低钾血症 

分 类 号：R54[医药卫生—心血管疾病]