高血压患者中原发性醛固酮增多症的检出率及特点

摘要

目的：探讨高血压患者中原发性醛固酮增多症（PA）的检出率及临床特点。方法197例高血压患者检测PA及其他相关指标，排除其他继发性高血压。将研究对象分PA组及原发性高血压组（EH组）。对2组患者行卧、立位试验，卡托普利试验或静脉高钠试验，血钾及肾上腺薄层CT，部分患者行午夜地塞米松抑制试验、促肾上腺皮质激素（ACTH）及性激素测定，主要指标为血醛固酮、肾素活性及醛固酮与肾素活性比值（ARR）。结果（1）197例高血压患者中确诊PA38例（19.29%），13例经病理诊断证实，醛固酮腺瘤6例，单侧肾上腺增生7例,未发现无功能腺瘤。（2）2组患者的高血压病程及体质指数（BMI）的差异无统计学意义，PA组及EH组男性均多于女性。（3）与EH组比较，PA组的起病年龄相对年轻，收缩压与舒张压水平更高，但差异均无统计学意义；PA组卧位、立位血醛固酮水平及ARR均显著升高，血肾素活性均显著下降（均P＜0.01），血钾水平差异无统计学意义。结论同期住院的高血压患者中PA的检出率较高，其中醛固酮腺瘤和单侧肾上腺增生的比例相近，低钾血症不常见。%Objective To study the detection rate and characteristics of primary aldosteronism (PA) in patients with hypertension. Methods A total of 197 patients with hypertension were enrolled and underwent PA and other related exami-nation to exclude the secondary hypertension. Patients were divided into two groups: PA group and essential hypertension (EH) group. The upright position test, supine position test, captopril test, venous high sodium test, potassium concentration examination and adrenal CT scanning were detected in two groups. Values of blood aldosterone, renin activity and aldoste-rone to renin activity ratio (ARR) were detected in some patients. Results (1) In 197 hypertensive patients, 38 were diag-nosed as PA (19.29%), 13 were confirmed by pathology, (6 cases aldosterone-producing adenoma and 7 unilateral adrenal hyperplasia). (2) There were no significant differences in the history of hypertension and body mass index (BMI) between two groups. There were more male patients than female patients in both groups. (3) Compared with EH group, there were relative-ly young age of onset, higher levels of systolic and diastolic blood pressure in PA group, but the difference was not statistical-ly significant (P>0.05). The levels of blood aldosterone and ARR were significantly increased in upright position and supine position in PA group (P<0.01), but the blood level of renin activity was significantly decreased(P<0.01). There was no sig-nificant significance in blood potassium level between two groups. Conclusion There was a higher detection rate of PA in patients hospitalized with hypertension. The detection rate of aldosterone-producing adenoma was similar to that of unilater-al adrenal hyperplasia in patients with PA. The hypokalemia was uncommon.