四川大学学报（医学版）2023，Vol.54Issue(6)：1227-1232,6.DOI:10.12182/20231160501
接受肾上腺切除术或螺内酯治疗的原发性醛固酮增多症患者代谢转归
Metabolic Outcomes of Primary Aldosteronism Patients Receiving Adrenalectomy or Spironolactone Treatments
摘要
Abstract
Objective To investigate the metabolic outcomes of primary aldosteronism(PA)patients receiving adrenalectomy(ADX)or spironolactone treatment and the contributing factors to the metabolic outcomes.Methods The clinical data of 70 patients with aldosterone-producing adenoma(APA)and 86 patients with idiopathic hyperaldosteronism(IHA)were retrospectively analyzed.All subjects received confirmatory diagnosis of APA or IHA at the Department of Endocrinology and Metabolism,West China Hospital between March 2018 and October 2020.APA patients underwent ADX,while IHA patients were given spironolactone,a mineralocorticoid receptor antagonist(MRA).After ADX or spironolactone treatment,the outcomes of the metabolic indicators and the inter-group differences between the APA patients and IHA patients were studied.Results There was no significant difference between the baseline data of the APA group and those of the IHA group in terms of age,sex,duration of hypertension,maximum systolic blood pressure(SBP-max),maximum diastolic blood pressure(DBP-max),body mass index(BMI),fasting blood glucose(FBG),lipid parameters,and renal function.IHA patients had higher waist circumference,serum potassium,and plasma renin activity(PRA)than those of the APA patients(all P＜0.05).All patients showed significant improvement in blood pressure,blood potassium,and plasma aldosterone at follow-up.However,they also showed increased triglycerides(TG)accompanied by deterioration in renal function(P≤0.001).Multiple regression showed that TG levels were associated with spironolactone treatment for IHA patients and post-treatment BMI and creatinine levels.Furthermore,APA patients showed improvement in their FBG after ADX(P=0.041),while IHA patients showed elevated levels of FBG after spironolactone treatment(P=0.037).Conclusion After treatment,PA patients still may experience abnormal lipid metabolism and deteriorating renal function.Spironolactone therapy may give rise to worse glucolipid metabolism than ADX therapy does.关键词
原发性醛固酮增多症/治疗方式/代谢转归Key words
Primary aldosteronism/Therapy/Metabolic outcome引用本文复制引用
许晨晓,陈涛,莫丹,张婷婷,周方励,田浩明,任艳..接受肾上腺切除术或螺内酯治疗的原发性醛固酮增多症患者代谢转归[J].四川大学学报（医学版）,2023,54(6):1227-1232,6.基金项目
国家重点研发计划(No.2021YFC2501601)、四川省科技厅重点研发项目(No.2023YFS0033)和四川大学华西医院2021年临床孵化项目重大项目(No.2021HXFH008)资助 （No.2021YFC2501601）
