接受肾上腺切除术或螺内酯治疗的原发性醛固酮增多症患者代谢转归  

Metabolic Outcomes of Primary Aldosteronism Patients Receiving Adrenalectomy or Spironolactone Treatments

作　　者：许晨晓 陈涛[1] 莫丹 张婷婷[3] 周方励[1] 田浩明[1] 任艳[1] XU Chenxiao;CHEN Tao;MO Dan;ZHANG Tingting;ZHOU Fangli;TIAN Haoming;REN Yan(Adrenal Disease Center,Department of Endocrinology and Metabolism,West China Hospital,Sichuan University,Chengdu 610041,China;Center for Clinical Epidemiology and Evidence-Based Medicine,West China Hospital,Sichuan University,Chengdu 610041,China;Health Management Center,General Practice Medical Center,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院内分泌代谢科肾上腺疾病诊治中心,成都610041 [2]四川大学华西医院临床流行病学与循证医学研究中心,成都610041 [3]四川大学华西医院全科医学中心,健康管理中心,成都610041

出　　处：《四川大学学报（医学版）》2023年第6期1227-1232,共6页Journal of Sichuan University(Medical Sciences)

基　　金：国家重点研发计划(No.2021YFC2501601);四川省科技厅重点研发项目(No.2023YFS0033);四川大学华西医院2021年临床孵化项目重大项目(No.2021HXFH008)资助。

摘　　要：目的 探讨原发性醛固酮增多症(原醛症)患者经肾上腺切除手术(ADX)或螺内酯治疗后的代谢转归及其影响因素。方法 回顾性分析2018年3月–2020年10月经四川大学华西医院内分泌科确诊的70例醛固酮瘤(APA)和86例特发性醛固酮增多症(IHA)患者的临床资料,APA组患者均进行ADX治疗,IHA患者均服用盐皮质激素受体拮抗剂(螺内酯)治疗,分析患者治疗后代谢指标的转归情况及组间差异。结果 APA组与IHA组患者治疗前年龄、性别、高血压病程、最高血压、最低血压、体质量指数(BMI)、血脂、空腹血糖、肾功能差异无统计学意义,IHA组患者的腰围、血钾水平和血浆肾素活性高于APA组(P均<0.05)。治疗后所有患者的血压、血钾及血浆醛固酮浓度显著改善,出现三酰甘油升高伴肾功能恶化(P≤0.001)。多因素回归显示三酰甘油水平与IHA组患者经螺内酯治疗、治疗后BMI及肌酐水平有关。APA组患者经肾上腺切除后空腹血糖改善(P=0.041),但IHA组患者经螺内酯治疗后空腹血糖升高(P=0.037)。结论 原醛症患者治疗后可能仍然存在糖脂代谢异常及肾功能恶化,螺内酯治疗可能有更差的代谢结局。Objective To investigate the metabolic outcomes of primary aldosteronism(PA)patients receiving adrenalectomy(ADX)or spironolactone treatment and the contributing factors to the metabolic outcomes.Methods The clinical data of 70 patients with aldosterone-producing adenoma(APA)and 86 patients with idiopathic hyperaldosteronism(IHA)were retrospectively analyzed.All subjects received confirmatory diagnosis of APA or IHA at the Department of Endocrinology and Metabolism,West China Hospital between March 2018 and October 2020.APA patients underwent ADX,while IHA patients were given spironolactone,a mineralocorticoid receptor antagonist(MRA).After ADX or spironolactone treatment,the outcomes of the metabolic indicators and the inter-group differences between the APA patients and IHA patients were studied.Results There was no significant difference between the baseline data of the APA group and those of the IHA group in terms of age,sex,duration of hypertension,maximum systolic blood pressure(SBP-max),maximum diastolic blood pressure(DBP-max),body mass index(BMI),fasting blood glucose(FBG),lipid parameters,and renal function.IHA patients had higher waist circumference,serum potassium,and plasma renin activity(PRA)than those of the APA patients(all P<0.05).All patients showed significant improvement in blood pressure,blood potassium,and plasma aldosterone at follow-up.However,they also showed increased triglycerides(TG)accompanied by deterioration in renal function(P≤0.001).Multiple regression showed that TG levels were associated with spironolactone treatment for IHA patients and post-treatment BMI and creatinine levels.Furthermore,APA patients showed improvement in their FBG after ADX(P=0.041),while IHA patients showed elevated levels of FBG after spironolactone treatment(P=0.037).Conclusion After treatment,PA patients still may experience abnormal lipid metabolism and deteriorating renal function.Spironolactone therapy may give rise to worse glucolipid metabolism than ADX therapy does.

关 键 词：原发性醛固酮增多症 治疗方式 代谢转归 

分 类 号：R586.24[医药卫生—内分泌]