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目的探讨高血压合并糖尿病住院患者中原发性醛固酮增多症(PA)的筛检流程、检出率以及特殊治疗后疗效的观察。方法回顾收集178例于2008年8月至2009年8月就诊于新疆维吾尔自治区人民医院高血压科的高血压合并糖尿病的住院患者,178例患者均已行常规坐位肾素、醛固酮浓度(PAC)测定、生化检测及人体学测量。满足坐位PAC/肾素活性值≥554 pmol/L·[μg/(L·h)]~(-1)患者被列为初筛阳性组,其余为初筛阴性组;初筛阳性组患者被建议行盐水输注试验,试验后PAC被抑制到138.5 pmol/L以下者排除PA,不被抑制在277 pmol/L以下者确诊为PA,其余患者需要结合临床确诊。结果 (1)48例初筛阳性组与130例阴性组比较,阳性组血钾[(3.7±0.4)mmol/L]低于阴性组[(3.9±0.4)mmol/L],差异有统计学意义(t=-3.40,P<0.01);(2)41例初筛阳性经盐水负荷试验后PA>138.5 pmol/L,占23.0%;其中25例负荷盐水后PAC≥277.0 pmol/L可确诊PA,检出率为14.0%;(3)41例患者中有23例接受了肾上腺静脉取血术(AVS),21例取血成功,操作成功率91.3%,其中6例定诊为单侧型PA,3例行单侧肾上腺病变切除术,其中2例术后病理证实为醛固酮瘤,1例为单侧肾上腺结节样增生;(4)23例已行AVS的PA患者经手术或盐皮质激素受体拮抗剂治疗后随访1~2年,与其治疗前比较,收缩压[(132.0±7.7)mmHg]低于治疗前[(150.0±14.0)mmHg],差异有统计学意义(t=5.63,P<0.01);舒张压[(85.0±7.0)mmHg]低于治疗前[(96.0±5.0)mmHg],差异有统计学意义(t=5.16,P<0.01);血钾[(4.0±0.3)mmol/L]高于治疗前[(3.5±0.4)mmol/L],差异有统计学意义(t=-5.45,P<0.01)。结论在高血压合并糖尿病患者中存在相当数量的PA,建议积极规范筛检及管理,针对病因施以特殊治疗,疗效肯定。
Objective To investigate the screening procedure, the detection rate and the curative effect of special aldosteronism (PA) in hypertensive patients with diabetes mellitus. Methods A total of 178 inpatients with hypertension complicated by diabetes admitted to the Hypertension Section of People ’s Hospital of Xinjiang Uyghur Autonomous Region from August 2008 to August 2009 were retrospectively reviewed. All 178 patients had regular sitting renin, aldosterone concentration (PAC) Determination, biochemical tests and anthropological measurements. Patients with positive PAC / renin activity ≥554 pmol / L · [μg / (L · h)] ~ (-1) were classified as primary screening positive group and the rest were primary screening negative group; Proposed saline infusion test, the PAC was suppressed to 138.5 pmol / L following the test to exclude PA, not suppressed below 277 pmol / L was diagnosed as PA, the remaining patients need to be combined with clinical diagnosis. Results (1) Compared with 130 negative patients, the positive serum potassium level in the positive group ([3.7 ± 0.4] mmol / L] was lower than that in the negative group [(3.9 ± 0.4) mmol / L] (P <0.01). (2) The positive rate of PA was 138.0 pmol / L in 41 cases of positive screening test, accounting for 23.0%. Among 25 cases, PAC≥277.0 pmol / L PA, the detection rate was 14.0%; (3) 23 of 41 patients underwent adrenal vein blood sampling (AVS), 21 of them were successful in blood sampling, the operation success rate was 91.3%, of which 6 were diagnosed as unilateral Type PA, 3 cases of unilateral adrenalectomy, 2 cases of pathological confirmed as aldosterone, 1 case of unilateral adrenal nodular hyperplasia; (4) 23 cases of patients with AVS have been treated by surgery or salt of PA The systolic blood pressure (132.0 ± 7.7) mmHg] was lower than that before treatment [(150.0 ± 14.0) mmHg] after treatment with corticosteroid receptor antagonists for 1 to 2 years. The difference was statistically significant (t = 5.63, P0.01). The diastolic blood pressure (85.0 ± 7.0) mmHg was lower than that before treatment (96.0 ± 5.0) mmHg, the difference was statistically significant (t = 5.16, P <0.01) ± 0.3) mmol / L] was higher than that before treatment [(3.5 ± 0.4) mmol / L], the difference was statistically significant (t = -5.45, P <0.01). Conclusions There is a considerable amount of PA in hypertensive patients with diabetes mellitus, and it is recommended to actively standardize the screening and management of patients with specific treatment for the cause of the disease with definite therapeutic effect.