406例原发性醛固酮增多症患者手术预后及影响因素分析  

Surgical prognosis and influencing factors in 406 patients with primary aldosteronism

作　　者：张益鑫 宋颖[1] 胡金波[1] 杨淑敏[1] 冯正平[1] 何文雯[1] 李启富[1] 赵文睿 Zhang Yixin;Song Ying;Hu Jinbo;Yang Shumin;Feng Zhengping;He Wenwen;Li Qifu;Zhao Wenrui(Department of Endocrinology,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内分泌科,重庆400016

出　　处：《中华内分泌代谢杂志》2024年第3期228-234,共7页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(U21A20355);国家重点研发计划"常见多发病防治研究"重点专项(2021YFC2501600,2021YFC2501603)

摘　　要：目的评估单侧原发性醛固酮增多症(简称原醛症)术后生化和临床缓解率,分析相关影响因素。方法回顾性纳入2013年11月至2022年3月在重庆医科大学附属第一医院内分泌科明确分型并接受肾上腺切除术且完成随访的406例原醛症患者,记录基线和术后的临床资料及生化指标。根据原发性醛固酮增多症手术预后(Primary Aldosteronism Surgical Outcome,PASO)标准进行临床和生化疗效评估。采用多因素logistic回归分析评估影响原醛症术后临床缓解的主要因素。结果406例原醛症患者术后的生化完全缓解率为96.31%(391/406),生化部分缓解率为0.99%(4/406),生化未缓解率为2.71%(11/406);临床完全缓解率为53.45%(217/406),临床部分缓解率为46.55%(189/406)。相比于临床部分缓解组,临床完全缓解组年龄较小,女性占比更大,体重指数较低,高血压病程更短,降压药的限定日剂量更低,估算的肾小球滤过率(eGFR)更高,高血压家族史和糖尿病病史所占比例较低。多因素logistic回归分析进一步显示,性别(OR=2.49,95%CI 1.42~4.35,P=0.001)、体重指数(OR=1.16,95%CI 1.05~1.28,P=0.003)、降压药限定日剂量(OR=1.83,95%CI 1.37~2.44,P<0.001)、高血压家族史(OR=2.16,95%CI 1.22~3.83,P=0.008)、糖尿病病史(OR=2.47,95%CI 1.15~5.29,P=0.021)和eGFR(OR=0.98,95%CI 0.97~0.99,P=0.001)是影响原醛症术后取得临床完全缓解的独立因素。结论单侧原醛症术后的生化完全缓解率较高,但仅有约一半患者实现临床完全缓解。Objective To evaluate postoperative biochemical and clinical remission rates in patients with unilateral primary aldosteronism and analyze related influencing factors.Methods A total of 406 patients of primary aldosteronism with confirmed subtyping,who underwent adrenalectomy and completed follow-up in the Department of Endocrinology of the First Affiliated Hospital of Chongqing Medical University from November 2013 to March 2022 were retrospectively enrolled.Clinical and biochemical data were recorded.Postoperative clinical and biochemical outcomes were assessed according to Primary Aldosteronism Surgery Outcome(PASO)consensus.Results Complete biochemical success was achieved in 391(96.31%)of 406 primary aldosteronism patients,while partial and absent biochemical success in only 4(0.99%)and 11(2.71%)primary aldosteronism patients;Complete clinical success was seen in 217(53.45%)patients,and partial clinical success in 189(46.55%)patients.Compared to the partial clinical success group,the complete clinical success group was younger,had a greater proportion of women,a smaller body mass index,a shorter duration of hypertension,a smaller daily defined dose value for antihypertensive medication,a higher estimated glomerular filtration rate(eGFR),and a lower proportion of family history of hypertension and diabetes mellitus.Multifactorial logistic regression analysis further showed that gender(OR=2.49,95%CI 1.42-4.35,P=0.001),body mass index(OR=1.16,95%CI 1.05-1.28,P=0.003),antihypertensive drug daily defined dose(OR=1.83,95%CI 1.37-2.44,P<0.001),family history of hypertension(OR=2.16,95%CI 1.22-3.83,P=0.008),history of diabetes(OR=2.47,95%CI 1.15-5.29,P=0.021),and eGFR(OR=0.98,95%CI 0.97-0.99,P=0.001)were independent factors influencing clinical prognosis of primary aldosteronism.Conclusion The postoperative complete biochemical success is higher in patients with unilateral primary aldosteronism,but only about half of all patients achieve complete clinical success.

关 键 词：原发性醛固酮增多症 单侧肾上腺切除术 预后 

分 类 号：R586.24[医药卫生—内分泌]