首页
期刊简介
编 委 会
期刊订阅
百年学会 医星璀璨
名院风范
学科风华
菁英风采
投稿须知
过刊浏览
联系我们
篇名
关键词
作者
作者单位
摘要
关键词
注册本刊作者
作者投稿查稿
专家远程审稿
编辑在线审稿
编务办公专区
主编办公专区
下载文档
《上海医学》审稿费代缴委托书
《上海医学》杂志2024年征订启事回执
《上海医学》期刊编审系统审稿专家使用手册
工作动态
03-05
《上海医学》杂志2024年度“春蕾杯”论文评比征文通知
06-14
创新驱动,培育人才—《上海医学》2021年度春蕾计划评审结果揭晓
01-21
《上海医学》期刊影响力指标和学科排名取得显著提升
01-20
《上海医学》恭祝大家新年快乐!
08-18
作废声明
联系方式
发行周期:
月刊
主管单位:
上海市卫生健康委员会
主办单位:
上海市医学会
编辑出版:
《上海医学》编辑部
联系地址:
上海市北京西路1623号
邮编:
200040
电话:
021-62178606
传真:
021-62178606
邮箱:
smasmj@shsma.org.cn
ISSN:
ISSN0253-9934
CN:
CN31-1366/R
收款账号:
1001255309008900719
账户名:
上海市医学会
开户行:
工商银行上海市静安寺支行
友情链接
上海市医学会
当前位置:首页 >
难治性高血压患者中原发性醛固酮增多症的筛查
Screening for primary aldosteronism in patients with resistant hypertension
浏览(748) 下载(1)
DOI:
作者:
赵家胜
ZHAO Jiasheng,LI Hong, LI Yin, LIU Qi
作者单位:
同济大学附属同济医院
Tongji Hospital of Tongji University
关键词:
难治性高血压;原发性醛固酮增多症;患病率
Resistant hypertension; Primary aldosteronism; Prevalence
摘要:
【摘要】目的 探讨难治性高血压患者中原发性醛固酮增多症(原醛症)的患病状况,并分析其临床特点。 方法 连续选择就诊于我院门诊的难治性高血压患者125例,于清晨8:00~9:00之间卧位采血测定血浆醛固酮(ALD, ng/dl)和肾素活性(PRA, ng/ml/h),然后计算醛固酮/肾素活性比值(ARR)。ARR >20 并且ALD>7.5ng/dl的患者接受生理盐水负荷试验,盐水负荷后血ALD仍大于7.5ng/dl者诊断为原醛症。原醛确诊后再进一步分型,所有患者均进行肾上腺薄层增强CT检查,其中有1例患者因难以判断是单侧还是双侧肾上腺病变接受了双侧肾上腺静脉采血检查。诊断为醛固酮瘤者在腹腔镜下行单侧肾上腺切除,诊断为特发性醛固酮增多症(特醛症)者加用盐皮质激素受体拮抗剂(螺内酯)治疗,并且随访患者的血压控制和血钾改善情况。结果 125例患者中31例(24.8%) ARR>20,其中24例(19.2%)ARR>20同时 ALD>7.5ng/dl的患者,接受生理盐水负荷试验。盐水输注后血ALD仍大于7.5ng/dl 者8例,确诊为原醛,本研究样本中原醛总的患病率为6.4%(8/125)。8例原醛中4例诊断为醛固酮瘤,在腹腔镜下行单侧肾上腺切除。另外4例诊断为特醛症的患者加用盐皮质激素受体拮抗剂-螺内酯治疗。半年随访结果表明,所有患者高血压获良好控制,低血钾治愈。结论 我们的资料显示难治性高血压人群中原醛的患病率低于以前国外的报道,其中一半为醛固酮瘤,高于其它报道。需要设计更大规模的、制定更严格入选标准的前瞻性研究进一步探讨中国难治性高血压患者中原醛的流行病学特点。
【Abstract】Objective To investigate the prevalence of primary aldosteronism(PA) in patients with resistant hypertension and describe the clinical features of the confirmed PA . Methods A total of 125 consecutive patients with resistant hypertension (blood pressure >140/90 mm Hg in spite of taking three or more antihypertensive medications at optimal doses, ideally including a diuretic), aged 18~65 years, who were referred to the outpatient department of our hospital, were enrolled for screening for primary aldosteronism. Plasma aldosterone(ALD) and plasma renin activity(PRA) were determined by radioimmunoassay , ALD (ng/dl) to PRA (ng/ml/h) ratio(ARR) was calculated. Patients with a positive test (ARR >20 and ALD>7.5ng/dl) underwent confirmatory saline infusion tests, who were diagnosed as suggestive of PA if the post-infusion ALD above 7.5ng/dl. Further classification of PA subtype was carried out by adrenal computed tomographic(CT) scan or adrenal vein sampling in one patient with equivocal findings on adrenal CT scan. Patients with aldosterone-producing adenoma (APA) underwent laparoscopic adrenalectomy, Patients with idiopathic hyperaldosteronism (IHA) were treated with mineralocorticoid receptor antagonist-spironolactone, All of them were followed up for six months. Results Of 125 patients with resistant hypertension,31(24.8%) had an elevated ARR(>20), 24(19.2%) had an elevated ARR with a concomitant aldosterone concentration(>7.5ng/dl). Only 8 patients had primary aldosteronism confirmed by saline infusion test. The overall prevalence of primary aldosteronism in the studied sample was 6.4%. 4 patients with APA underwent unilateral laparoscopic adrenalectomy, another 4 patients with IHA were treated with spironolactone, All of them displayed a marked improvement in hypertension control and cure of hypokalemia. Conclusion Our data suggest that the prevalence of primary aldosteronism in patients with resistant hypertension would be substantially lower than previously reported. Half of the patients with PA have APA, It seems to be higher than other reports. A large-scale prospective study with more strict inclusion criteria should be designed in order to exactly assess the epidemiologic characteristics of primary aldosteronism in Chinese patients with resistant hypertension.
点击下载DOC全文