基于倾向性评分匹配分析原发性醛固酮增多症患者心脑血管病变特征  

Characteristics of cardiovascular and cerebrovascular diseases in patients with primary aldosteronism: a propensity score matching study

作　　者：万爽 陈涛[1] 田浩明[1] 任艳[1] Wan Shuang;Chen Tao;Tian Haoming;Ren Yan(Adrenal Center,Department of Endocrinology and Metabolism,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Endocrinology,Chongqing Hospital of Traditional Chinese Medicine,Chongqing 400021,China)

机构地区：[1]四川大学华西医院内分泌与代谢科、肾上腺疾病诊治中心,成都610041 [2]重庆市中医院内分泌科,重庆400021

出　　处：《中华内科杂志》2025年第4期302-308,共7页Chinese Journal of Internal Medicine

基　　金：四川省科技厅重点研发项目(2023YFS0033);四川大学华西医院临床孵化项目重大项目(2021HXFH008)。

摘　　要：目的:分析原发性醛固酮增多症(PA)患者合并心脑血管病变的特征,并与年龄、性别、血压等相匹配的原发性高血压(EH)患者比较。方法:横断面研究。收集2018年12月至2021年12月四川大学华西医院确诊的PA及EH患者临床资料;分析两组的人口学特征、卒中事件、冠状动脉及外周血管病变、心脏结构及功能等;采用倾向性评分匹配(PSM)均衡非研究性数据,采用独立样本t检验、Wilcoxon符号秩和检验、χ^(2)检验等进行组间比较,并比较单侧型PA与双侧型PA的心脑血管病变差异。结果:共纳入336例PA患者、369例EH患者。PSM后,两组各198例患者进入分析,其年龄、性别、血压水平等差异无统计学意义。PA组卒中患病率显著高于EH组[12.6%(25/198)比5.6%(11/198),P=0.014],主要为缺血性卒中较EH组明显升高[10.0%(20/198)比4.5%(9/198),P=0.029];PA组出血性卒中、冠状动脉病变、外周动脉狭窄、主动脉硬化、动脉瘤的患病率也高于EH组,但差异无统计学意义(均P>0.05)。PA合并左心室肥厚[22.2%(44/198)比9.1%(18/198)]、左心房增大[40.4%(80/198)比30.3%(60/198)]、室间隔增厚[50.0%(99/198)比36.9%(73/198)]、主动脉增宽[21.7%(43/198)比13.1%(26/198)]的比例较EH高(均P<0.05)。单侧型PA合并左心室肥厚[28.3%(51/180)比13.4%(11/82),P=0.013]的比例较双侧型PA高。结论:与年龄、性别、血压等相匹配的EH患者相比,PA患者发生卒中风险更大,心脏结构受损更加严重。单侧型PA患者心脏损害程度更重。Objective:To analyze the characteristics of cardiovascular and cerebrovascular diseases in patients with primary aldosteronism(PA)and compare them with age-,sex-,and blood pressure-matched patients with essential hypertension(EH).Methods:This cross-sectional study was conducted at the West China Hospital of Sichuan University.Patients with PA and EH between December 2018 and December 2021 were included.Demographic characteristics,stroke events,coronary artery diseases,peripheral vascular diseases,and cardiac structure and function indicators were analyzed.Propensity score matching(PSM)was used to balance non-study data.The t-test,chi-square test,and Wilcoxon signed-rank test were used for data comparison.The cardiovascular and cerebrovascular damage in the patients with unilateral and bilateral PA were also compared.Results:A total of 336 and 369 patients with PA and EH,respectively,were enrolled in this study.One hundred and ninety-eight patients from each group were included after PSM;no significant differences were found in terms of age,gender,and blood pressure.The prevalence of stroke in the PA group was considerably higher than that in the EH group[12.6%(25/198)vs.5.6%(11/198),P=0.014],due to the significantly greater risk of ischemic stroke[10.0%(20/198)vs.4.5%(9/198),P=0.029].The prevalence of hemorrhagic stroke,coronary artery disease,peripheral arterial stenosis,aorta atherosclerosis,and aneurysm in the PA group were also higher than those in the EH group,but there was no statistical significance(all P>0.05).More patients with PA had concurrent left ventricular hypertrophy[22.2%(44/198)vs.9.1%(18/198)],left atrial enlargement[40.4%(80/198)vs.30.3%(60/198)],ventricular septal thickening[50.0%(99/198)vs.36.9%(73/198)],and aortic widening[21.7%(43/198)vs.13.1%(26/198)]than those with EH(all P<0.05).Compared with the bilateral PA group,the unilateral PA group had higher prevalence of left ventricular hypertrophy[28.3%(51/180)vs.13.4%(11/82),P=0.013].Conclusions:Compared with well-matched patients with EH,pa

关 键 词：原发性醛固酮增多症 原发性高血压 心脑血管病变 卒中 

分 类 号：R54[医药卫生—心血管疾病]