原发性醛固酮增多症术后高血压未治愈的危险因素

doi:10.19723/j.issn.1671-167X.2022.04.017

摘要/Abstract

摘要：

目的: 分析原发性醛固酮增多症患者术后高血压未治愈的危险因素，评价ARS(aldosteronoma resolution score)对于原发性醛固酮增多症术后高血压状态的预测价值。方法: 选择2018年1月—2021年6月于北京大学人民医院行手术治疗的原发性醛固酮增多症患者的病例资料进行回顾性分析，根据术后高血压疾病状态，将患者分为高血压治愈组和高血压未治愈组，比较不同预后组间术前相关因素差异，分析原发性醛固酮增多症患者手术后高血压不缓解的危险因素，并评估ARS对于预测原发性醛固酮增多症术后高血压治愈的价值。结果: 共纳入112例患者，至少6个月术后随访后，大多数患者(94.6%)都达到术后高血压完全缓解或部分缓解。根据患者术后高血压状态，将患者分为高血压治愈组(51例)和高血压未治愈组(61例)。两组间患者年龄、体重指数、腰围、高血压病程、术前降压药物种类、术前收缩压、糖尿病病史、心脑血管疾病病史、血清肌酐、估算肾小球滤过率(estimated glomerular filtration rate，eGFR)、高密度脂蛋白胆固醇和甘油三酯差异有统计学意义。Logistic回归分析发现年龄(OR=1.111，95%CI：1.029~1.199)、腰围(OR=1.073，95%CI：1.013~1.137)、术前收缩压(OR=1.033，95%CI：1.008~1.060)和心脑血管疾病病史(OR=16.061，95%CI：1.312~196.612)是原发性醛固酮增多症患者术后高血压未治愈的危险因素，但性别并不是高血压未治愈的危险因素。高血压治愈组患者中位ARS为4分，而未治愈组为2分，在ARS4~5分患者中，术后高血压治愈率为76.5%，ARS的ROC曲线下面积(AUC)为0.743。结论: 心脑血管疾病病史是术后高血压不治愈的重要危险因素，ARS对于预测原发性醛固酮增多症术后高血压状态有一定价值，但仍需进一步研究设计出更适合中国人群的原发性醛固酮增多症手术结果的预测模型。

关键词: 原发性醛固酮增多症, 肾上腺切除术, 高血压

Abstract:

Objective: To analyze the risk factors of persistent hypertension in patients who underwent adrenalectomy for primary aldosteronism and to evaluate the predictive value of the aldosteronoma resolution score (ARS) scoring system for surgical outcomes of adrenalectomy for primary aldosteronism. Methods: We reviewed the clinical characteristics of patients who underwent adrenalectomy for primary aldosteronism from 2018 to 2021 at Peking University People' s Hospital to recognize risk factors of uncured hypertension after surgery. Based on the patient' s clinical outcomes, the patients were divided into complete success group and partial/absent success group. Risk factors for persistent hypertension were analyzed. The value of the ARS scoring system was assessed by the area under the curve (AUC). Results: In this study, 112 patients were included. Most of the patients benefited from the surgery for 94.6% were a complete or partial clinical success after follow-up for at least 6 months. According to postoperative hypertension status, the patients were divided into complete success group (51 cases) and partial/absent success group (61 cases). There were statistical differences between the two groups in age, body mass index (BMI), waist circumference, duration of hypertension, number of preoperative antihypertension medications, preoperative systolic blood pressure, history of diabetes, history of cardiovascular and cerebrovascular diseases, serum creatinine, estimated glomerular filtration rate(eGFR), high-density lipoprotein cholesterol and triglyceride. Logistic regression analysis showed that age (OR=1.111, 95%CI: 1.029-1.199), waist circumference (OR=1.073, 95%CI: 1.013-1.137), pre-operative systolic blood pressure (OR=1.033, 95%CI: 1.008-1.060) and history of cardiovascular and cerebrovascular diseases (OR=16.061, 95%CI: 1.312-196.612) were the risk factors for uncured hypertension in primary aldosteronism patients after surgery, but female gender not. The median ARS in the complete success group was 4 and in the partial/absent success group, it was 2. Among the patients with ARS of 4-5, the cure rate of hypertension was 76.5%. The area under the curve of ARS was 0.743. Conclusion: The history of cardiovascular and cerebrovascular diseases is a significant risk factor for persistent hypertension after surgery in primary aldosteronism patients. ARS scoring system has a certain value in predicting the postoperative hypertension status of primary aldosteronism patients. However, further research is still needed on a prediction model for surgical outcomes of primary aldosteronism which is more suitable for the Chinese population is still needed.

Key words: Primary aldosteronism, Adrenalectomy, Hypertension

中图分类号:

R699

皇甫宇超,杜依青,于路平,徐涛. 原发性醛固酮增多症术后高血压未治愈的危险因素[J]. 北京大学学报（医学版）, 2022, 54(4): 686-691.

Yu-chao HUANG-FU,Yi-qing DU,Lu-ping YU,Tao XU. Risk factors of persistent hypertension in primary aldosteronism patients after surgery[J]. Journal of Peking University (Health Sciences), 2022, 54(4): 686-691.

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参考文献 24

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Items	Complete success(n=51)	Partial/absent success(n=61)	P
Femal，n(%)	26 (51.0)	21 (34.4)	0.087
Age/years，$\bar x \pm s$	40.6±8.6	50.9±9.8	＜0.001
BMI/(kg/m²)，$\bar x \pm s$	25.0±3.6	27.2±4.0	0.002
Waist circumference/cm，$\bar x \pm s$	86.6±11.2	95.22±10.1	＜0.001
Duration of hypertension/months，M(P₂₅, P₇₅)	36 (12, 60)	120 (60, 240)	＜0.001
Number of preoperative antihypertensive medications，M(P₂₅, P₇₅)	2 (1, 3)	3 (2, 3)	0.001
SBP/mmHg，M(P₂₅, P₇₅)	170 (155, 180)	180 (170, 210)	＜0.001
DBP/mmHg，M(P₂₅, P₇₅)	102 (100, 120)	110 (92, 120)	0.391
History of preoperative hypokalemia，n(%)	43 (84.3)	48 (78.7)	0.477
Diabetes mellitus，n(%)	3 (5.9)	14 (23.0)	0.016
Cardiovascular or cerebrovascular disease，n(%)	1 (2.0)	22 (36.1)	＜0.001
Lowest serum potassium concentration on record/(mmol/L)，M(P₂₅, P₇₅)	2.8 (2.4, 3.2)	3.0 (2.5, 3.1)	0.638
Serum K⁺/(mmol/L)，M(P₂₅, P₇₅)	4.0 (3.7, 4.3)	4.1 (3.6, 4.4)	0.250
Serum Na⁺ /(mmol/L)，M(P₂₅, P₇₅)	140.4 (138.8, 142.0)	140.0 (138.6, 141.0)	0.222
Serum creatine/(μmol/L)，M(P₂₅, P₇₅)	72.0 (60.0, 84.0)	82.0 (71.0, 95.5)	0.004
eGFR[mL/(min·1.73 m²)]，M(P₂₅, P₇₅)	102.9 (91.7, 111.0)	88.5 (71.4, 102.0)	＜0.001
HDL-C /(mmol/L)，M(P₂₅, P₇₅)	1.11 (0.99, 1.46)	0.99 (0.89, 1.16)	0.011
TG /(mmol/L)，M(P₂₅, P₇₅)	1.07 (0.83, 1.60)	1.43 (0.88, 2.11)	0.045
Cortisol(8：00)/(μg/dL)，M(P₂₅, P₇₅)	10.4 (8.6, 12.4)	10.8 (8.9, 13.4)	0.471
DRC/(mIU/L)，M(P₂₅, P₇₅)	1.5 (0.8, 3.4)	2.2 (1.0, 6.1)	0.226
PAC/(ng/dL)，M(P₂₅, P₇₅)	37.4 (21.0, 47.6)	35.7 (23.4, 54.7)	0.474
ARR/[(ng/dL)/(mU/L)]，M(P₂₅, P₇₅)	17.7 (8.4, 54.8)	14.5 (6.6, 36.0)	0.478

Variable	Univariate		Multivariate
Variable	Crude OR(95%CI)	P	Adjusted OR(95%CI)	P
Age	1.123 (1.069-1.180)	＜0.001	1.111 (1.029-1.199)	0.007
Female	0.505 (0.236-1.081)	0.079
BMI	1.174 (1.054-1.308)	0.004
Waist circumference	1.081 (1.037-1.126)	＜0.001	1.073 (1.013-1.137)	0.017
Duration of hypertension	1.017 (1.009-1.025)	＜0.001
Number of preoperative antihypertensive medications	1.870 (1.237-2.828)	0.003
SBP	1.035 (1.016-1.054)	＜0.001	1.033 (1.008-1.060)	0.010
Diabetes mellitus(Yes)	4.766 (1.286-17.667)	0.019
Cardiovascular or cerebrovascular disease(Yes)	28.205 (3.641-218.502)	0.001	16.061 (1.312-196.612)	0.030
Serum creatine	1.028 (1.007-1.049)	0.009
eGFR	0.961 (0.940-0.982)	＜0.001
HDL-C	0.152 (0.035-0.667)	0.013
TG	1.450 (0.857-2.452)	0.166