诊断学理论与实践 ›› 2020, Vol. 19 ›› Issue (05): 450-453.doi: 10.16150/j.1671-2870.2020.05.002
陈歆1, 程艾邦1,2, 许建忠1,2, 李燕1,2, 王继光1,2
收稿日期:
2020-07-01
出版日期:
2020-10-25
发布日期:
2022-07-14
Received:
2020-07-01
Online:
2020-10-25
Published:
2022-07-14
中图分类号:
陈歆, 程艾邦, 许建忠, 李燕, 王继光. 中国高血压患者原发性醛固酮增多症的前瞻性筛查研究进展[J]. 诊断学理论与实践, 2020, 19(05): 450-453.
表1
参与筛查登记的原醛患者资料(n=218)
项目 | 疑似原醛患者 (n=218) |
---|---|
女性[n(%)] | 135(61.9) |
年龄(岁) | 56.8±18.2 |
筛查原因[n(%)] | |
持续性血压>160/100 mmHg或难治性高血压 | 100(45.9) |
高血压合并自发性或利尿剂所致的低血钾 | 47(21.6) |
高血压合并肾上腺意外瘤 | 27(12.4) |
早发高血压或脑卒中家族史的高血压患者 | 25(11.5) |
高血压合并阻塞型呼吸睡眠暂停综合征[n(%)] | 27(12.4) |
原醛患者的一级亲属中患高血压者[n(%)] | 13(6.0) |
ARR检测[n(%)] | |
坐位或立位 | 153(70.2) |
卧位 | 49(22.5) |
坐位或立位+卧位 | 16(7.3) |
确诊试验[n(%)] | 109(50.0) |
卡托普利试验 | 73(33.5) |
静脉生理盐水滴注试验 | 32(14.7) |
卡托普利+静脉生理盐水滴注试验 | 4(1.8) |
血检查指标 | |
血钾(mmol/L) | 3.76±0.58 |
肌酐(μmol/L) | 62.30±15.20 |
尿酸(μmol/L) | 308.00±94.00 |
三酰甘油(mmol/L) | 1.86±1.45 |
总胆固醇(mmol/L) | 4.59±1.22 |
高密度脂蛋白胆固醇(mmol/L) | 1.21±0.37 |
低密度脂蛋白胆固醇(mmol/L) | 2.63±0.81 |
合并疾病[n(%)] | |
脑卒中 | 48(22.0) |
冠心病 | 39(17.9) |
糖尿病 | 42(19.3) |
[1] |
Rimoldi SF, Scherrer U, Messerli FH. Secondary arterial hypertension: when, who, and how to screen?[J]. Eur Heart J. 2014 May 14; 35(19):1245-1254.
doi: 10.1093/eurheartj/eht534 |
[2] |
Hundemer GL, Vaidya A. Primary aldosteronism diagnosis and management: a clinical approach[J]. Endocrinol Metab Clin North Am, 2019, 48(4):681-700.
doi: 10.1016/j.ecl.2019.08.002 URL |
[3] |
Käyser SC, Dekkers T, Groenewoud HJ, et al. Study hete-rogeneity and estimation of prevalence of primary aldosteronism: a systematic review and meta-regression analysis[J]. J Clin Endocrinol Metab, 2016, 101(7):2826-2835.
doi: 10.1210/jc.2016-1472 URL |
[4] |
Monticone S, Burrello J, Tizzani D, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice[J]. J Am Coll Cardiol, 2017, 69(14):1811-1820.
doi: S0735-1097(17)30569-7 pmid: 28385310 |
[5] |
Umpierrez GE, Cantey P, Smiley D, et al. Primary aldosteronism in diabetic subjects with resistant hypertension[J]. Diabetes Care, 2007, 30(7):1699-1703.
doi: 10.2337/dc07-0031 URL |
[6] |
Prejbisz A, Florczak E, Klisiewicz A, et al. Relationship between primary aldosteronism and obstructive sleep apnoea, metabolic abnormalities and cardiac structure in patients with resistant hypertension[J]. Endokrynol Pol, 2013, 64(5):363-367.
doi: 10.5603/EP.2013.0019 URL |
[7] |
Calhoun DA, Nishizaka MK, Zaman MA, et al. Aldosterone excretion among subjects with resistant hypertension and symptoms of sleep apnea[J]. Chest, 2004, 125(1):112-117.
pmid: 14718429 |
[8] |
Di Murro A, Petramala L, Cotesta D, et al. Renin-angiotensin-aldosterone system in patients with sleep apnoea: prevalence of primary aldosteronism[J]. J Renin Angiotensin Aldosterone Syst, 2010, 11(3):165-172.
doi: 10.1177/1470320310366581 URL |
[9] |
Li M, Ge Q, Sheng CS, et al. Clinical characteristics of snoring patients with primary aldosteronism and obstructive sleep apnea-hypopnea syndrome[J]. J Hum Hypertens, 2019, 33(9):693-700.
doi: 10.1038/s41371-019-0208-9 URL |
[10] |
Monticone S, D'Ascenzo F, Moretti C, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis[J]. Lancet Diabetes Endocrinol, 2018, 6(1):41-50.
doi: 10.1016/S2213-8587(17)30319-4 URL |
[11] |
Milliez P, Girerd X, Plouin PF, et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism[J]. J Am Coll Cardiol, 2005, 45(8):1243-1248.
pmid: 15837256 |
[12] |
Rossi GP, Maiolino G, Flego A, et al. Adrenalectomy lowers incident atrial fibrillation in primary aldosteronism patients at long term[J]. Hypertension, 2018, 71(4):585-591.
doi: 10.1161/HYPERTENSIONAHA.117.10596 URL |
[13] |
Rossi GP, Cesari M, Cuspidi C, et al. Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism[J]. Hypertension, 2013, 62(1):62-69.
doi: 10.1161/HYPERTENSIONAHA.113.01316 URL |
[14] |
Zhu L, Zhang Y, Zhang H, et al. Comparison between adrenal venous sampling and computed tomography in the diagnosis of primary aldosteronism and in the guidance of adrenalectomy[J]. Medicine (Baltimore), 2016, 95(39):e4986.
doi: 10.1097/MD.0000000000004986 URL |
[15] | Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrino-logy Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors[J]. Eur J Endocrinol, 2016, 175(2):G1-G34. |
[16] | 中华医学会内分泌学分会肾上腺学组. 原发性醛固酮增多症诊断治疗的专家共识[J]. 中华内分泌代谢杂志, 2020, 36(9):727-736. |
[17] | Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[J]. Hypertension, 2018, 71(6):e13-e115. |
[18] | 冷敏, 刘爱云, 司家峰, 等. 化学发光法检测鲁西健康人群肾素-血管紧张素-醛固酮系统参考范围及影响因素[J]. 国际检验医学杂志, 2018, 39(15):1910-1914. |
[19] |
Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline[J]. J Clin Endocrinol Metab, 2016, 101(5):1889-1916.
doi: 10.1210/jc.2015-4061 pmid: 26934393 |
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