原醛症患者血浆肾素活性与肾脏损害的关系  

Unsuppressed renin activity and secondary hypertensive kidney damage in primary hyperaldosteronism

作　　者：邵远[1] 张祖豹[1] 吴瑜璇[1] 

机构地区：[1]上海第二医科大学附属瑞金医院泌尿外科,200025

出　　处：《中华泌尿外科杂志》2003年第6期374-376,共3页Chinese Journal of Urology

摘　　要：目的　探讨原醛症肾素活性与高血压肾脏损害之间的关系。　方法　收集 76例原发性醛固酮增多症患者高血压病程、治疗前血清肌酐、醛固酮以及基础和激发肾素活性资料 ,分析肌酐值与其他各指标的相关性。　结果　患者治疗前血清肌酐值与激发肾素活性之间相关性有极显著性意义 (P <0 .0 0 1) ,而与高血压病程、醛固酮以及基础肾素活性无关。 76例中有 8例肾素活性不受抑制 ,其中 4例血清肌酐值升高 ,且在服用安体舒通时继续上升 ,显著高于肾素抑制者 (P <0 .0 0 1)。此4例患者治疗前血压较高 ,1例术后仍需药物控制血压。　结论　部分原醛症患者肾素活性不受抑制 ,可能与高血压导致肾脏损害有关 ,应密切监视肾功能和血钾 ,谨慎使用安体舒通。Objective To detect plasma renin activity(PRA) and kidney damage in primary hyperaldosteronism(PA). Methods The duration of hypertension,serum creatinine and aldosterone levels,recumbent and upright PRA levels were detected and studied in 76 PA patients.Correlation was measured between creatinine and other parameters. Results Serum creatinine level correlates closely with upright PRA ( P <0.001).No correlation was found between serum creatinine and duration of hypertension,aldosterone levels,or recumbent PRA levels.Among these 76 cases,8 had unsuppressed upright PRA which were greater than 3.0 ng·ml -1 ·h -1 .4 of these 8 had their creatinine elevated and the percentage was significantly higher than these cases with suppressed PRA ( P <0.001) and the creatinine level became even higher on receiving spironolactone therapy.These 4 patients had higher blood pressure before treatment and one of them still needed anti-hypertension drugs after surgery. Conclusions PA patients without suppressed PRA were probably due to secondary hypertensive kidney damage.In these cases,careful observation of serum creatinine and potassium is required during spironolactone therapy.

关 键 词：原发性醛固酮增多症 高血压 肾脏损害 肾素 

分 类 号：R586.24[医药卫生—内分泌]