2型糖尿病伴难治性高血压中原发性醛固酮增多症的患病情况

摘要

目的 评价2型糖尿病合并难治性高血压人群中原发性醛固酮增多症的患病率及临床特征.方法 对106例2型糖尿病、服用不少于3种降压药物血压仍高于140/90 mmHg的患者进行筛查,检测肾素活性与醛固酮比值,如>30 ng/(mL·h),则进一步行静脉盐水试验,若醛固酮水平>10 ng/dL则确诊为原发性醛固酮增多症.观察其发病率及临床特征.结果 36例肾素活性与醛固酮比值高于30 ng/(mL·h),16例经静脉盐水试验确诊为原发性醛固酮增多症(原醛组).原醛组和原发性高血压组相比较,组间性别、年龄、病程、血压控制、服用药物数量及品种差异无统计学意义,但血钾显著降低[(3.74±0.43)mmol/L vs (4.18±0.44)mmol/L,P<0.05],PAC水平显著增高[(18.86±8.54)ng/dL vs (12.15±6.78)ng/dL,P＜0.01],PRA水平显著降低[(0.2±0.1)ng/mL vs (2.9±1.2)ng/mL,P＜0.01],且肾素活性与醛固酮比值也显著增高[89(42,146) vs 18(6,33)ng/(mL·h),P＜0.01].结论 原先性醛固酮增多症在2型糖尿病合并难治性高血压中发病率较高,应常规进行筛查.%Objective To survey the prevalence of primary aldosteronism ( PA) in type 2 diabetes mellitus (T2DM) patients with resistant hypertension. Methods A total of 106 subjects with T2DM and resistant hypertension (defined as blood pressure > 140/90mmHg despite the use of > or = 3 antihypertensive agents ) , were screened for PA by measuring the plasma aldosterone (PAC) - to - plasma renin activity (PRA) ratio. Subjects with PAC - to - PRA ratio over 30 ng/( mL· h) received confirmatory salt load testing with diagnostic criteria of PAC 10 ng/dl. Results PAC - to - PRA ratio over 30 ng/(mL· h) was observed in 36 subjects , among which 16 subjects had confirmed diagnosis of PA. There was no difference in age , glycemic control, or the number of antihypertensive drugs revealed between subjects with and without PA. However, comparing those without PA , the subjects with PA had significantly lower serum potassium (3. 74±0. 43 mmol/L vs 4. 18 ±0.44 mmol/L, P<0.05), lower PRA (0.2±0.1 ng/mL vs 2. 9 ±1. 2 ng/mL, P< 0. 01) and higher PAC (18. 86 ±8. 54 ng/dL vs 12. 15 ± 6. 78 ng/dL, P < 0. 01) , and higher PAC - to - PRA ratio (89 (42,146)ng/(mL·h) vs 18(6,33) ng/(mL·h),P<0.01). Conclusion PA is common in patients with T2DM and resistant hypertension , which requires conventional screening .