原发性醛固酮增多症术后血压恢复的影响因素分析  

Analysis of the risk factors of postoperative blood pressure recovery in the patients with primary aldosteronism

作　　者：李卓颖 何云锋[1] 张尧[1] 全真 郭远 吴小候[1] LI Zhuoying;HE Yunfeng;ZHANG Yao;QUAN Zhen;GUO Yuan;WU Xiaohou(Department of Urology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院泌尿外科,400016

出　　处：《重庆医学》2022年第17期2936-2941,共6页Chongqing medicine

基　　金：国家自然科学基金项目(81802543)。

摘　　要：目的探究原发性醛固酮增多症患者术后高血压持续存在的影响因素。方法回顾性分析2014年1月至2020年12月该院收治的294例原发性醛固酮增多症高血压患者资料,根据术后血压恢复情况分为高血压组及治愈组,分析比较两组性别、年龄、血压、BMI、高血压病程、高血压家族史、糖尿病、高血压性心脏病、难治性高血压史、服药种类、血浆醛固酮/肾素(ARR)、醛固酮、肾素、最低血钾、估计肾小球滤过率(eGFR)、肿瘤直径、病变部位、手术方式、病理结果等资料,随访患者术后血压、醛固酮、肾素,并纳入分析。结果与治愈组比较,高血压组年龄更大,男性比例、收缩压、舒张压、BMI、高血压家族史、糖尿病、高血压性心脏病、难治性高血压患者比例更高,高血压病程更长,服药种类更多,ARR、醛固酮、eGFR水平更低,肾素、最低血钾、甘油三酯水平更高,肿瘤直径更小,病理检查结果提示增生的患者比例更高,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,男性、高血压病程、糖尿病、ARR均为术后高血压持续存在的影响因素(P<0.05)。结论应针对原发性醛固酮增多症术后影响血压的危险因素进行干预。Objective To explore the risk factors for the persistent hypertension after surgical intervention in the patients with primary aldosteronism.Methods A total of 294 patients from January 2014 to December 2020 with primary aldosteronism and hypertension treated in this hospital were enrolled in this study.The patients were divided into the hypertension group and the cure group according to the blood pressure level after surgery.The characteristics of gender,age,blood pressure,BMI,duration of hypertension,family history of hypertension,presence of diabetes mellitus,presence of hypertensive heart disease,history of refractory hypertension,type of medication,plasma aldosterone/renin(ARR),aldosterone,renin,minimum serum potassium,estimated glomerular filtration rate(eGFR),tumor diameter,lesion lateral direction,mode of operation,pathological results were analyzed and compared between the two groups.Postoperative blood pressure,postoperative aldosterone and postoperative renin were followed up and analyzed.Results Compared with those of the cure group,the hypertension group was older,with a higher proportion of male,systolic blood pressure,diastolic blood pressure,BMI,family history of hypertension,diabetes,hypertensive heart disease,refractory hypertension,longer course of hypertension,more types of medication,lower levels of ARR,aldosterone,eGFR,higher levels of renin,minimum blood potassium and triglyceride,smaller tumor diameter,and higher proportion of patients with hyperplasia.The difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that male,duration of hypertension,diabetes mellitus,and ARR were the influencing factors for persistent hypertension after surgery(P<0.05).Conclusion The risk factors affecting blood pressure after operation of primary aldosteronism should be intervened.

关 键 词：原发性醛固酮增多症 预后 持续性高血压 肾上腺切除术 醛固酮腺瘤 

分 类 号：R699.3[医药卫生—泌尿科学]