原发性醛固酮增多症合并无症状肾结石/肾钙沉着症的特征及其影响因素研究  

Clinical Features and Associated Factors of Asymptomatic Nephrolithiasis/Nephrocalcinosis in Primary Aldosteronism

作　　者：曹旭[1] 朱显军[1] 杨艳[1] 唐镍 刘丽梅[1] 周卉[1] 张磊[1] 朱颖[1] 杨毅[1] 夏伟 刘佑韧[1] CAO Xu;ZHU Xianjun;YANG Yan;TANG Nie;LIU Limei;ZHOU Hui;ZHANG Lei;ZHU Ying;YANG Yi;XIA Wei;LIU Youren(Department of Endocrinology,Sichuan Provincial People's Hospital/Sichuan Academy of Medical Sciences,Chengdu 610072,China)

机构地区：[1]四川省人民医院内分泌科四川省医学科学院,四川省成都市610072

出　　处：《中国全科医学》2022年第21期2635-2639,2645,共6页Chinese General Practice

基　　金：四川省医学会高血压疾病专项科研课题(2019TG12);四川省医学会高血压疾病(施慧达)专项科研课题(2017SHD007)。

摘　　要：背景目前关于原发性醛固酮增多症(PA)与泌尿系结石间相关性研究几乎仅见于个案报告,且大多数报道与肾钙沉着症相关,检索既往文献,PA合并无症状肾结石/肾钙沉着症的患病率、临床特点及致病危险因素研究目前罕有报道。目的探讨四川地区PA患者合并无症状肾结石/肾钙质沉着症的特征及其影响因素。方法回顾性分析2017年1月至2021年4月四川省人民医院内分泌科诊治的147例PA患者的临床资料,包括性别、年龄、高血压病程、低钾血症病程、病史中最低血钾值、糖代谢异常、吸烟史、饮酒史、入院时收缩压(SBP)、入院时舒张压(DBP)、体质指数(BMI)、腰围;估算肾小球滤过率(eGFR)、血尿酸(UA)、总蛋白(TP)、白蛋白(Alb)、空腹血糖(FBG)、血钾(K)、血钠(Na)、血钙(Ca)、血镁(Mg)、血磷(P)、血二氧化碳(CO;)、血pH值、血碳酸氢盐(HCO;)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、糖化血红蛋白(HbA;)、立位醛固酮(PAC)、立位肾素(DRC)、立位PAC/DRC比值(ARR)、25羟维生素D〔25(OH)D〕、甲状旁腺激素(PTH);24 h尿电解质(K、Na、Ca、Mg、P)、尿微量白蛋白/肌酐比值(ACR)、尿pH值。147例PA患者根据是否合并无症状肾结石/肾钙沉着症分为PA合并无症状肾结石/肾钙沉着症组34例和单纯PA组113例。采用二元Logistic回归分析探讨PA合并无症状肾结石/肾钙沉着症的独立危险因素。结果与单纯PA组相比,PA合并无症状肾结石/肾钙沉着症组男性比例、吸烟史、饮酒史、血pH、血HCO;、血PTH水平高,高血压病程长,eGFR水平低(P<0.05);二元Logistic回归分析结果显示,血PTH水平〔OR=1.009,95%CI(1.001,1.017),P=0.034〕是PA合并无症状肾结石/肾钙沉着症的影响因素。结论合并无症状肾结石/肾钙沉着症的PA患者有以下临床特征:男性居多、高血压病程更长、更高的吸烟及饮酒比例、更高的血pH、HCO;和PBackground Urinary calculi in primary aldosteronism(PA)have been studied almost only in case reports,and most of which have been reported to be associated with nephrolithiasis.Literature review demonstrates that there are few reports on the prevalence,clinical characteristics and possible causative factors of asymptomatic nephrolithiasis/nephrocalcinosis in PA.Objective To investigate clinical features and possible causative factors of asymptomatic nephrolithiasis/nephrocalcinosis in primary aldosteronism patients in Sichuan.Methods In this retrospective study,we enrolled 147 PA patients from Department of Endocrinology,Sichuan Provincial People’s Hospital from January 2017 to April 2021,including 34 also with asymptomatic nephrolithiasis/nephrocalcinosis and 113 patients with PA alone.Clinical data were collected,including sex,age,duration of hypertension,duration of hypokalemia,the lowest serum potassium level in medical history,abnormal glucose metabolism,smoking history,drinking history,systolic blood pressure at admission,diastolic blood pressure at admission,body mass index,waist circumference,estimated glomerular filtration rate(eGFR),fasting blood glucose,serum uric acid,total protein,albumin,potassium,sodium,calcium,magnesium,phosphorus,carbon dioxide,pH value,bicarbonate(HCO;),total cholesterol,triglyceride,low-density lipoprotein,high-density lipoprotein,and glycated hemoglobin,plasma aldosterone concentration,direct renin concentration,and aldosterone-renin ratio in upright posture,serum 25 hydroxyvitamin D,and parathyroid hormone(PTH),24-hour urinary electrolyte excretion(K,Na,Ca,Mg,P),urine microalbumin to creatinine ratio,and urinary pH value.Binary Logistic regression analysis was used to explore the independent risk factors of asymptomatic nephrolithiasis/nephrocalcinosis in PA.Results Compared with patients with PA alone,those also with asymptomatic nephrolithiasis/nephrocalcinosis had higher proportion of males,previous or current smokers,and previous or current drinkers,higher mean levels of

关 键 词：醛固酮增多症 肾结石 肾钙盐沉着 疾病特征 影响因素分析 

分 类 号：R586.24[医药卫生—内分泌]