螺内酯治疗后原发性醛固酮增多症患者醛固酮逃逸的发生率及影响因素  

The incidence and influencing factors of aldosterone escape in PA patients after spironolactone treatment

作　　者：周明双 郑绍莹 张雯 易春秀 李雪 赵雅静 ZHOU Mingshuang;ZHENG Shaoying;ZHANG Wen;YI Chunxiu;LI Xue;ZHAO Yajing(Department of Hypertension,Yunnan Fuwai Cardiovascular Disease Hospital,Kunming,650102,China)

机构地区：[1]云南省阜外心血管病医院高血压病区,昆明650102

出　　处：《临床心血管病杂志》2024年第2期100-107,共8页Journal of Clinical Cardiology

基　　金：云南省科技厅-昆明医科大学联合专项面上项目(No:202101AY070001-221,202101AY070001-222);云南省心血管病临床医学中心项目(No:FZX2019-06-01);云南省心血管系统疾病临床医学研究中心-重大心血管疾病诊治新技术研发(No:202103AC100004)。

摘　　要：目的:探讨螺内酯治疗后原发性醛固酮增多症(PA)患者醛固酮逃逸的发生率及影响因素。方法:回顾性分析2021年1月—2023年3月云南省阜外心血管病医院收治的144例PA患者资料,根据螺内酯治疗前后醛固酮浓度变化分为非逃逸组和逃逸组,比较两组患者用药前临床资料,同时分析影响因素。结果:144例PA患者中68例患者发生了醛固酮逃逸,醛固酮逃逸发生率为47.22%。与非逃逸组相比,逃逸组用药前肾功能不全比例更低,血浆醛固酮(立位)、醛固酮(卧位)、尿素氮(BUN)、同型半胱氨酸(HCY)、C反应蛋白(CRP)、三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)水平及尿微量白蛋白/肌酐更低,差异有统计学意义(均P<0.05)。单因素logistic回归分析显示,用药前肾功能不全病史、血浆醛固酮(立位)、醛固酮(卧位)、T3、FT3、促甲状腺激素(TSH)水平是PA患者治疗后醛固酮逃逸的影响因素(分别为β=-0.985,OR=0.373,P=0.031;β=-0.063,OR=0.938,P=0.002;β=-0.060,OR=0.942,P=0.014;β=-1.103,OR=0.332,P=0.029;β=-0.631,OR=0.532,P=0.010;β=-0.249,OR=0.780,P=0.044)。多因素logistic回归分析显示,用药前血浆醛固酮(立位)、FT3、TSH水平是PA患者治疗后发生醛固酮逃逸的独立危险因素(分别为β=-0.053,OR=0.949,P=0.031;β=-0.910,OR=0.402,P=0.042;β=-0.379,OR=0.685,P=0.013)。结论:部分PA患者在螺内酯治疗后出现醛固酮逃逸现象,用药前血浆醛固酮(立位)、FT3、TSH水平是该现象的独立危险因素。Objective:To investigate the incidence and influencing factors of aldosterone escape in patients with primary aldosteronism(PA)after spironolactone treatment.Methods:The data of 144patients with PA admitted to Fuwai Cardiovascular Disease Hospital in Yunnan Province from January 2021to March 2023were retrospectively analyzed.According to the changes of aldosterone concentration before and after spironolactone treatment,they were categorized into non-escape group and escape group.The clinical data of the two groups were compared before the administration of spironolactone,and the influencing factors were analyzed at the same time.Results:Aldosterone escape occurred in 68of 144patients with PA,and the incidence of aldosterone escape was 47.22%.Compared with the non-escape group,the escape group had a lower proportion of pre-dose renal insufficiency,and lower plasma aldosterone(standing),aldosterone(lying),urea nitrogen(BUN),homocysteine(HCY),C-reactive protein(CRP),triiodothyronine(T3),thyroxine(T4),free triiodothyronine(FT3)levels,and urinary microalbumin/creatinine,and the differences were statistically significant(all P<0.05).One-way logistic regression analysis showed that history of renal insufficiency,plasma aldosterone(standing),aldosterone(lying),T3,FT3,and thyroid-stimulating hormone(TSH)levels prior to medication were correlated with the occurrence of post-treatment aldosterone escape in patients with PA(β=-0.985,OR=0.373,P=0.031;β=-0.063,OR=0.938,P=0.002;β=-0.060,OR=0.942,P=0.014;β=-1.103,OR=0.332,P=0.029;β=-0.631,OR=0.532,P=0.010;β=-0.249,OR=0.780,P=0.044).Multifactorial logistic regression analysis showed that pre-dose plasma aldosterone(standing),FT3,and TSH levels were independent risk factors for the occurrence of aldosterone escape after treatment in PA patients(β=-0.053,OR=0.949,P=0.031;β=-0.910,OR=0.402,P=0.042;β=-0.379,OR=0.685,P=0.013).Conclusion:Some patients with PA experienced aldosterone escape after spironolactone treatment,and pre-dose plasma aldosterone(standing),FT3,and TSH lev

关 键 词：原发性醛固酮增多症 螺内酯 醛固酮逃逸 

分 类 号：R544.1[医药卫生—心血管疾病]