摘要
目的:调查新诊断糖尿病合并高血压患者中原发性醛固酮增多症(primary aldosteronism,PA)的患病率,比较新诊断糖尿病伴原发性高血压(essential hypertension,EH)和PA患者的临床差异,探讨血浆醛固酮浓度(plasm aldosterone concentration,PAC)与临床生化指标间的关系。方法:前瞻性连续纳入新诊断糖尿病合并高血压患者共270名。对所有患者进行PA初筛试验,阳性者行卡托普利试验进行PA确诊;同时检测所有患者的临床生化指标。结果:270名新诊断糖尿病合并高血压患者中PA患病率为18.5%。与EH组比较,PA组患者收缩压(systolic blood pressure,SBP)、PAC、血浆醛固酮/肾素活性比值(aldosterone to renin ratio,ARR)及二氧化碳结合力显著升高(均P<0.01),血浆肾素活性(plasma renin activity,PRA)及血钾显著降低(均P<0.01)。相关性分析显示:在EH组中PAC与胰岛素抵抗指数(homeostasis model assessment-insulin resistance,HOMA-IR)呈正相关(r=0.139,P<0.05),而在PA组中无此相关性。与SBP<140 mmHg组患者相比,SBP≥160 mmHg组患者PRA和血钾显著降低(分别P<0.05,P<0.001),PA患者比例、ARR显著升高(分别P<0.05,P<0.01)。结论:新诊断糖尿病合并高血压患者PA患病率较高,对2级以上高血压患者,应积极筛查PA。患有PA的糖尿病合并高血压患者血压更高;新诊断糖尿病合并高血压患者的PAC可能与胰岛素抵抗相关。
Objective:To investigate the prevalence of primary aldosteronism(PA)in newly diagnosed diabetic patients with hypertension and to compare clinical differences between newly diagnosed diabetes mellitus with essential hypertension(EH)and PA,and to explore the relationship between plasm aldosterone concentration(PAC)and clinical biochemical variables.Methods:A total of 270 newly diagnosed diabetic patients with hypertension were prospectively enrolled in this study.All patients were screened for PA.The positive patients in the screening test were further confirmed by captopril challenge test(CCT)to determine the prevalence of PA.Clinical biochemical indexes were detected.Results:The prevalence of PA in 270 newly diagnosed diabetic patients with hypertension was 18.5%.Compared with patients in the EH group,patients in the PA group had higher systolic blood pressure(SBP),PAC,aldosterone to renin ratio(ARR),and carbondioxide binding force,but lower plasma renin activity(PRA)and serum potassium.Correlation analysis showed that the PAC was positively correlated with homeostasis model assessment-insulin resistance(HOMA-IR)in the EH group(r=0.139,P<0.05),but the correlation was not found in the PA group.Compared with patients with SBP<140 mmHg,patients with SBP≥160 mmHg had the significantly decreased PRA and potassium(P<0.05,P<0.001,respectively),but increased ARR and proportion in the PA patients(P<0.05,P<0.01,respectively).Conclusion:The prevalence of PA is relatively high in newly diagnosed diabetic patients with hypertension.Patients with hypertension above grade 2 should be actively screened for aldosterone.Newly diagnosed diabetic patients with hypertension combined with PA has a higher hypertension compared with the patients without PA.In newly diagnosed diabetic patients with hypertension,PAC may be related to insulin resistance.
作者
胡宇航
刘玮
张晶晶
苏欣
HU Yuhang;LIUWei;ZHANG Jingjing;SU Xin(Department of Metabolism and Endocrinology,Second Xiangya Hospital,Central South University,National Clinical Research Center for Metabolic Diseases,Key Laboratory of Diabetes Immunology,Ministry of Education,Changsha 410011,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2020年第8期923-928,共6页
Journal of Central South University ：Medical Science
基金
湖南省科技厅重点研发计划(2017sk2022)。
