原发性醛固酮增多症患者24 h血尿同步电解质特征分析  

The features of 24-hour urine and paired serum electrolytes in hypertensive patients with primary aldosteronism

作　　者：王梦卉[1] 彩丽[1] 骆秦[1] 张德莲[1] 胡君丽[1] 张玮玮[1] 赵建雯 李南方[1] WANG Meng-hui;CAI Li;LUO Qin;ZHANG Delian;HU Jun-li;ZHANG Wei-wei;ZHAO Jian-wen;LI Nan-fang(Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Hypertension Institute,National Health Committee Key Laboratory of Hypertension Clinical Research,Urumuqi,Xinjiang 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院高血压中心,新疆高血压研究所,国家卫生健康委高血压诊疗研究重点实验室,新疆乌鲁木齐830001

出　　处：《中华高血压杂志》2021年第9期860-866,共7页Chinese Journal of Hypertension

基　　金：新疆维吾尔自治区自然科学基金计划基金项目(2018D01C096)。

摘　　要：目的探讨原发性醛固酮增多症(PA)患者的24 h血尿同步电解质的特点。方法回顾性分析2009年1月至2014年1月就诊于新疆维吾尔自治区人民医院高血压中心,规范进行PA筛查并完善24 h血尿同步离子测定的高血压患者764例,其中PA患者135例,非PA患者629例。结果与非PA组比较,PA组血清钾离子[(3.66±0.41)比(3.86±0.37)mmol/L]、血清磷离子[(1.08±0.16)比(1.16±0.19)mmol/L]及钙磷乘积[(29.7±5.2)比(32.4±6.9)(mg/dL)^(2)]较低,而尿液钾离子[41.5(31.6~52.4)比35.9(27.7~46.3)mmol/L]、尿液钙离子[6.0(4.5~8.1)比5.2(3.9~6.9)mmol/L]、尿液镁离子[3.8(3.1~5.0)比3.5(2.7~4.6)mmol/L]、血钠与尿钠的比值除以血钾平方与尿钾比值[(血钠/尿钠)/(血钾^(2)/尿钾),SUSPPUP][2.48(1.71~3.95)比1.96(1.39~2.73)(mmol/L)^(-1)]较高(P<0.01)。低钾血症、低钙血症、尿钾>54.1 mmol/L、尿钙>7.5 mmol/L及钙磷乘积<35(mg/dL)2在PA患者中的检出率明显升高(均P<0.05)。结论除已知PA患者低钾血症、血钙降低及尿钾、尿钙高排的电解质特征外,PA患者血液电解质特点还表现为血磷水平降低及尿镁水平升高;此外,复合离子指标:高SUSPPUP及低钙磷乘积也是PA的电解质特征。Objective To investigate the features of 24-hour urine and paired serum electrolytes in hypertensive patients with primary aldosteronism(PA).Methods A total of 764 hypertensive patients,who underwent PA screening and completed the measurement of 24-hour urine and paired serum electrolytes from January 2009 to January 2014 at Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region were included.Of which,135 patients were diagnosed with PA,whereas 629 patients were non-PA patients.Results Compared with the non-PA group,serum potassium[(3.66±0.41)vs(3.86±0.37)mmol/L],serum phosphorus[(1.08±0.16)vs(1.16±0.19)mmol/L]and calcium-phosphorus product[(29.7±5.2)vs(32.4±6.9)(mg/dL)^(2)]in PA group were lower,and urine potassium[41.5(31.6-52.4)vs 35.9(27.7-46.3)mmol/L],urine calcium[6.0(4.5-8.1)vs 5.2(3.9-6.9)mmol/L],urine magnesium[3.8(3.1-5.0)vs 3.5(2.7-4.6)mmol/L],the ratio of blood sodium to urine sodium divided by the ratio of blood potassium squared to urine potassium(SUSPPUP)[2.48(1.71-3.95)vs 1.96(1.39-2.73)(mmol/L)^(-1)]in PA group were higher(P<0.01).Hypokalemia,hypocalcemia,urinary potassium>54.1 mmol/L,urinary calcium>7.5 mmol/L and calcium phosphorus product<35(mg/dL)^(2) were more frequently observed in PA patients(P<0.05).Conclusions In addition to hypokalemia,hypocalcemia and high urinary potassium and calcium excretion,electrolyte characteristics in patients with PA are also manifested as decreased serum phosphorus and increased urinary magnesium.Electrolyte in patients with PA are also charactered by two comprehensive ion indexes:high SUSPPUP ratio and low calcium and phosphorus product.

关 键 词：高血压 原发性醛固酮增多症 电解质 血清 尿液 

分 类 号：R586.24[医药卫生—内分泌]