四川地区汉族不同亚型原发性醛固酮增多症临床特点分析  

Analysis of clinical characteristics of different subtypes of primary aldosteronism in Han nationality in Sichuan area

作　　者：曹旭[1] 朱显军[1] 唐镍 刘丽梅[1] 周卉[1] 张磊[1] 朱颖[1] 杨毅[1] 夏伟 包明晶[1] 吴冀川[1] 张学军[1] 杨艳[1] CAO Xu;ZHU Xian-jun;TANG Nie;LIU Li-mei;ZHOU Hui;ZHANG Lei;ZHU Ying;YANG Yi;XIA Wei;BAO Ming-jing;WU Ji-chuan;ZHANG Xue-jun;YANG Yan(Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital, Chengdu 610072, China)

机构地区：[1]四川省医学科学院·四川省人民医院内分泌科,四川成都610072

出　　处：《实用医院临床杂志》2022年第1期26-31,共6页Practical Journal of Clinical Medicine

基　　金：四川省医学会高血压疾病专项科研课题基金资助项目(编号:2019TG12)。

摘　　要：目的探讨四川地区不同亚型原发性醛固酮增多症(PA)患者临床特点。方法对2017年1月至2021年1月四川省人民医院内分泌科确诊的131例四川地区汉族PA患者的临床资料进行回顾性分析,通过肾上腺影像学、双侧肾上腺静脉采血、术后病理分型为醛固酮瘤(APA)组32例、特发性醛固酮增多症组(IHA)22例和原发性肾上腺皮质增生组(PAH)8例。比较三组的临床特征。结果①131例PA患者确诊时中位年龄52岁,高血压病程中位时间4年,合并低钾血症率为67.18%,合并糖代谢异常率为35.88%;②APA组发病年龄最年轻,且好发于女性,相较于IHA组,APA组患者的血钠、尿微量白蛋白/尿肌酐比值、立位醛固酮(PAC)、立位醛固酮/肾素直接浓度比值、生理盐水负荷试验及卡托普利抑制试验前后PAC水平更高,而血钾、血钙、血总蛋白、血白蛋白、血尿酸水平更低(P<0.05)。结论四川地区汉族PA患者好发于中年女性,且低钾血症发生率总体高于国外研究报道。不同亚型PA患者的临床表现存在一定差异性,其中APA患者更年轻,合并更显著的电解质紊乱、早期微量白蛋白尿、高醛固酮血症及高血容量临床特点。Objective To investigate the clinical characteristics of patients with different subtypes of primary aldosteronism(PA)in Sichuan province.Methods Clinical data of 131 PA patients diagnosed at department of endocrinology of our hospital from January 2017 to January 2021 were retrospectively analyzed.The patients were divided into aldosteronoma group(APA group,n=32),idiopathic aldosteronism group(IHA group,n=22)and primary adrenal hyperplasia group(PHA group,n=8)by using adrenal imaging,bilateral adrenal venous blood sampling and postoperative pathological classification.The clinical characteristics were compared among the three groups.Results The median age of the 131 PA patients was 52 years old,the median course of hypertension was 4 years,the rate of complicated hypokalemia was 67.18%,and the rate of complicated glucose metabolism abnormality was 35.88%.In the APA group,patients were the youngest,most of patients were women,and the incidence of hypokalemia was the highest,accounting for 81.25%when compared with other two groups.Compared to the IHA group,patients in the APA group had higher levels of serum sodium,urine microalbumin/urine creatinine ratio,ortho aldosterone(PAC),PAC/renin direct concentration ratio,and had higher PAC levels before and after the saline stress test and captopril inhibition test.The patients in the APA group also showed lower levels of serum potassium,blood calcium,blood total protein,blood albumin,and blood uric acid.The differences were statistically significant(P<0.05).Conclusion PA patients of Han nationality in Sichuan area are more likely to occur in middle-aged females,and the incidence of hypokalemia is generally higher than that of foreign research reports.Patients with different subtypes of PA have certain differences in clinical manifestations.Among the PA patients,APA patients are younger with more significant electrolyte disturbance,early microalbuminuria,hyperaldosteronemia,and high blood volume.

关 键 词：原发性醛固酮增多症 醛固酮瘤 特发性醛固酮增多症 原发性肾上腺皮质增生 

分 类 号：R586[医药卫生—内分泌]