原发性醛固酮增多症患者血钙磷乘积和不同体位血浆肾素与糖脂代谢水平变化及意义  

Changes of and significances of calcium-phosphorus product,aldosterone rennin ratio in different postures and glycolipid metabolism in primary aldosteronism patients

作　　者：王晓辉 高传玉 赵秋平 董佳佳 WANG Xiao-hui;GAO Chuan-yu;ZHAO Qiu-ping;DONG Jia-jia(Heart Center,Zhengzhou University People's Hospital,Fuwai Central China Cardiovascular Hospital,Henan Provincial People's Hospital,Henan Hypertension Prevention and Therapy Center,Zhengzhou,Henan 451464,China)

机构地区：[1]郑州大学人民医院、阜外华中心血管病医院、河南省人民医院心脏中心、河南省高血压防治中心,河南郑州451464

出　　处：《中华实用诊断与治疗杂志》2023年第4期393-397,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划项目(GJ20210104)。

摘　　要：目的观察原发性醛固酮增多症(primary aldosteronism,PA)患者钙磷乘积、血钾、血浆醛固酮与直接肾素浓度比值(aldosterone rennin ratio,ARR)及糖脂代谢水平变化,探讨其对PA的诊断价值。方法行静脉盐水负荷试验诊断为PA的高血压患者119例为PA组,同期原发性高血压患者170例为原发组。比较2组入院时血压,尿钾、钠,血钾、钠、钙、磷,空腹血糖(fasting plasma glucose,FPG),糖化血红蛋白(glycosylated hemoglobin A_(1)c,HbA_(1)c)、三酰甘油(triacylglycerol,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇水平(high-density lipoprotein cholesterol,HDL-C),胰岛素抵抗指数(homeostasis model assessment-insulin resistance,HOMA-IR),钙磷乘积,卧位及立位血浆ARR。采用Pearson相关法分析PA患者ARR、血钾、钙磷乘积与TC、TG、LDL-C、HDL-C、FPG、HbA_(1)c、HOMA-IR的相关性;采用多因素logistic回归分析高血压患者发生PA的影响因素;绘制ROC曲线,评估血钾、钙磷乘积、卧位及立位ARR诊断PA的效能。结果PA组收缩压[(150.12±9.97)mm Hg]、尿钾[(51.15±9.89)mmol/L]、卧位ARR(62.51±9.84)、立位ARR(50.72±8.56)均高于原发组[(142.21±8.89)mm Hg、(45.59±8.90)mmol/L、29.36±6.53、21.43±6.39](P<0.05),血钾、钙、磷、钙磷乘积、TC、TG、LDL-C、FPG、HbA_(1)c水平及HOMA-IR均低于原发组(P<0.05),体质量指数、舒张压、血钠、尿钠、HDL-C水平及糖尿病比率与原发组比较差异均无统计学意义(P>0.05)。卧位ARR、立位ARR与TC、TG、LDL-C、HbA_(1)c、HOMA-IR均呈负相关(P<0.05);血钾、钙磷乘积与TC、TG、LDL-C、HbA_(1)c、HOMA-IR均呈正相关(P<0.05)。血钾(OR=0.537,95%CI:0.412~0.699,P<0.001)、钙磷乘积(OR=0.641,95%CI:0.472~0.870,P<0.001)、卧位ARR(OR=1.950,95%CI:1.360~2.797,P<0.001)、立位ARR(OR=1.844,95%CI:1.345~2.528,P<0.001)是高血压患者发生PA的影响因素。血钾、钙磷乘积、卧位�Objective To investigate the clinical characteristics and prognosis of fulminant myocarditis(FM) in children. Methods The clinical data of 22 children with FM were retrospectively analyzed, including clinical manifestations, markers of myocardial injury, electrocardiography, echocardiography, abdominal ultrasonography and prognosis. Results In 22 children with FM, 2 were aged 3 to 8 months, 1 was aged 1 to 2 years, 4 were aged 3 to 6 years, 10 were aged 7 to 10 years and 5 were aged 12 to 15 years. At onset, 12 children had gastrointestinal symptoms, 11 had neurological symptoms, 8 had cardiac symptoms, 6 had respiratory symptoms, and 16 had hypoperfusion signs as poor spirit, pale complexion, low heart sound and cold extremities. All 22 children had myocardial injury markers abnormalities, including elevated creatine kinase isoenzyme in 17 children, elevated troponin T in 15, elevated troponin I level in 7 and elevated B-type natriuretic peptide in 17. The electrocardiography showed ST-T changes in 20 children, atrioventricular block in 10, complete right bundle branch block in 5, complete left bundle branch block in 2, and tachyarrhythmia in 5(ventricular tachycardia in 3 and atrial tachycardia in 2). In 13 children with abnormal echocardiography, heart enlargement occurred in 8, left ventricular ejection fraction decreased in 12, pericardial effusion occurred in 4 and ventricular wall movement was abnormal in 3. Ten of these 12 children with gastrointestinal symptoms at onset had abnormal abdominal ultrasound results. The treatment included administration of human immunoglobulin in 19 children, large-dose glucocorticoid shock therapy in 15, full-dose glucocorticoid therapy in 4, temporary pacemaker implantation in 6, extracorporeal membrane pulmonary oxygenation in 3, continuous renal replacement therapy in 2, extracorporeal membrane pulmonary oxygenation combined with continuous renal replacement therapy in 1, and mechanical ventilation in 6. Twenty children were discharged in good condition(8 cases of Adams-

关 键 词：原发性醛固酮增多症 高血压 醛固酮与直接肾素浓度比值 血钾 钙磷乘积 糖脂代谢 

分 类 号：R586.24[医药卫生—内分泌]