原发性醛固酮增多症与原发性高血压的糖脂代谢比较

摘要

Objective : To compare the characteristics of glucolipid metabolism between patients with primary aldosteronism (PA) and those with essential hypertension (EH). Methods:We recruited 431 cases diagnosed as primary aldosteronism, 256 patients having adrenal venous sampling (AVS). According to the results of AVS, all subjects were divided into two groups: 147 patients with lateralized primary aldosteronism (LPA) and 109 patients with nonlateralized primary aldosteronism (NLPA). A total of 200 matched patients with essential hypertension were used as controls. The clinical data of patients in each group were collected, calculated for the prevalence of PA, and compared in the glucolipid metabolism characteristics. Results: (1) The prevalence of PA was 10.54% (431/4100) ; (2) Body mass index (BMI) and waistline in PA group was higher than those in EH group; (3) Triglycerides levels in LPA was higher than in NLPA and EH, and high-density lipoprotein in NLPA group was lower than in EH; (4) Post-prandial serum glucose and insulin levels, and insulin resistance index were higher in PA than in EH group, and those in NLPA was higher than in LPA group within PA groups (5) BMI can increase the risk of LPA group (OR = 2. 24, P = 0.024); (6) Triglycerides levels was significantly positively correlated with urine aldosterone, BMI was positively correlated with sitting aldosteronism levels, post-prandial serum insulin levels and insulin resistance index were significantly positively correlated with serum aldosterone and urine aldosterone levels. Conclusion: Abnormalities of glucolipid metabolism in PA group are severe (especially LPA was more severe than NLPA in lipid metabolism and NLPA was more severe compared with LPA in glucose metabolism) than those in EH group.%目的:比较原发性醛固酮增多症与原发性高血压的糖脂代谢特征. 方法:431例已确诊的原发性醛固酮增多症(PA)患者,其中256例行肾上腺静脉取血,分为原醛单侧组(LPA,n=147)、原醛双侧组(NLPA,n=109).同时入选与性别、年龄、及高血压病程相匹配的同期住院原发性高血压(EH)患者200例为对照组.收集各组的临床资料和生化指标,计算PA检出率并分析糖脂代谢特点. 结果:(1)PA检出率为10.54％(431/4100);(2)体重指数、腰围PA组较EH组高；(3)血三酰甘油LPA组高于NLPA组和EH组,高密度脂蛋白NLPA较EH组低；(4)血糖水平、血胰岛素各点及胰岛素抵抗指数均PA组高于EH组,且NLPA组高于LPA组；(5)体重指数可增加LPA组危险性(OR值=2.24,P=0.024)；(6)三酰甘油与尿醛固酮呈显著正相关,体重指数与卧位醛固酮水平呈正相关,各点胰岛素水平和胰岛素抵抗指数均与醛固酮水平和尿醛固酮呈显著正相关. 结论:与EH患者相比,PA糖脂代谢异常程度重,其中LPA脂代谢以及NLPA组糖代谢异常更为严重.