亚临床原发性醛固酮增多症的特征及其治疗研究  

Characteristics and treatment of subclinical primary aldosteronism

作　　者：刘小丽 张和轩 何洪波 赵志钢 闫振成 祝之明 杨刚毅[1] LIU Xiao-li;ZHANG He-xuan;HE Hong-bo;ZHAO Zhi-gang;YAN Zhen-cheng;ZHU Zhi-ming;YANG Gang-yi(Endocrinology Department,Second Affiliated Hospital of Chongqing Medical University,Center for Hypertension and Metabolic Diseases,Department of Hypertension and Endocrinology,Daping Hospital,The Army Medical University,Chongqing Institute of Hypertension,Chongqing 400042,China)

机构地区：[1]重庆医科大学第二附属医院内分泌科、陆军军医大学大坪医院高血压与内分泌科、高血压与代谢疾病中心、重庆高血压研究所,重庆400042

出　　处：《中国实用内科杂志》2024年第11期933-937,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81920108010);陆军特色医学院中心的课题(ZXYZZKY06)。

摘　　要：目的通过把亚临床原发性醛固酮增多症(SPA)与原发性醛固酮增多症(PA)的患者及原发性高血压(EH)患者之间比较,分析SPA的特征点,并同时观察其治疗后的情况。方法收集2019年9月至2023年10月在陆军特色医学中心高血压与内分泌科新诊断的高血压患者986例,其年龄段在18~70岁,依据血浆醛固酮与肾素比值(ARR)及盐水负荷抑制试验(SIT)结果将其分组,ARR筛查正常的549例患者进入原发性高血压组(EH组),ARR异常但SIT试验阴性的96例患者进入SPA组,ARR异常但SIT试验阳性的107例患者进入PA组,分析3组特点,同时随访了SPA组治疗后的情况。结果3组间在收缩压、舒张压均差异无统计学意义,PA组和SPA组心率高于EH组[(81.8±12.2)次/min比(81.3±12.5)次/min比(74.0±10.7)次/min,P<0.0001];在生化特征中PA组和SPA组的醛固酮水平显着高于EH组(17.3 ng/dL比11.1 ng/dL比8.8 ng/dL,P<0.0001),SPA组醛固酮水平低于PA组;PA组和SPA组的ARR显着高于EH组(9.0比6.5比0.8,P<0.0001),SPA组肾素水平低于PA组;PA组和SPA组的血清钾水平低于EH组[(3.51±0.52)mmol/L比(3.78±0.34)mmol/L比(4.02±0.31)mmol/L,P<0.0001];SPA组的该值高于PA组。经治疗后,SPA组患者收缩压下降11.1 mmHg,舒张压下降4.8 mmHg;然而,76.5%的SPA患者必须服用2种或多种药物,有少数药物疗效不佳者,经外科手术治疗达到了完全的临床及生化缓解。结论SPA的临床及生化特征比原发性高血压的患者明显,接近PA的特征,故需早期识别与积极干预,有助于预防远期心脑血管并发症。Objective To analyze the characteristics of subclinical primary aldosteronism(SPA)by comparing the patients with SPA and primary aldosteronism(PA) with those with essential hypertension, and to observe the condition after treatment.Methods A total of 986 patients with hypertension newly diagnosed at the Department of Hypertensive Endocrinology of the Army Specialty Medical Center from September 2019 to October 2023,aged 18 to 70 years,were collected and grouped according to plasma aldosterone to renin ratio(ARR)and saline stress suppression test(SIT)results.A total of 549 patients with normal ARR screening were enrolled in the essential hypertension group(EH group),96patients with abnormal ARR but negative SIT test were enrolled in the SPA group,and 107 patients with abnormal ARR but positive SIT test were enrolled in the PA group. The characteristics of the three groups were analyzed,and the condition after treatment in the SPA group was followed up. Results There were no significant differences in systolic or diastolic blood pressure among the three groups,but the heart rate of PA(81.8±12.2 per minute)and SPA(81.3±12.5 per minute)groups was higher than that of EH group(74.0±10.7)(P< 0.0001). Aldosterone levels in biochemical characteristics in PA(17.3 ng/d L)and SPA(11.1 ng/d L)groups were significantly higher than those in EH group (8.8 ng/d L)(P< 0.0001),while the aldosterone level in SPA group was lower than that in PA group. The ARR of PA(9.0)and SPA(6.5)groups was significantly higher than that of EH group(0.8)(P< 0.0001),and the renin level in SPA group was lower than that in PA group;the serum potassium level in PA[(3.51±0.52)mmol/L]and SPA[(3.78±0.34)mmol/L]groups was lower than that in EH[(4.02±0.31)mmol/L]group(P< 0.0001),and the serum potassium level in SPA group was higher than that in PA group. After treatment,the systolic blood pressure and diastolic blood pressure in SPA group decreased by 11.1 mm Hg and 4.8 mm Hg respectively. However,76.5% of SPA patients were required to take two or more

关 键 词：原发性醛固酮增多症 亚临床原发性醛固酮增多症 醛固酮 血浆醛固酮与肾素比值 盐水负荷试验 高血压 

分 类 号：R54[医药卫生—心血管疾病]