摘要
目的探讨原发性醛固酮增多症(PA)合并肾上腺性库欣综合征(ACS)的临床特点,为临床诊治提供依据。方法抽取2017年6月至2022年6月武警河南总队医院收治的PA患者71例,根据是否合并ACS分为观察组(PA合并ACS患者,16例)和对照组(单纯PA患者,55例)。所有患者均有完整的临床资料,比较两组患者的临床特点。结果两组性别、体质指数、合并症、发病侧比较差异未见统计学意义(P>0.05),但观察组患者年龄及病灶长径均大于对照组(P均<0.05);两组血清钾、空腹血糖、糖化血红蛋白、立位肾素活性、立位血醛固酮水平比较差异未见统计学意义(P>0.05),但观察组1 d内24∶00时的血清皮质醇水平高于对照组(P<0.05),观察组1 d内不同时点(8∶00、16∶00、24∶00)的血浆促肾上腺皮质激素(ACTH)水平均低于对照组(P均<0.05)。术后随访3个月,两组在病理结果、肾上腺双侧病变性质、肾上腺皮质功能不全方面比较差异未见统计学意义(P>0.05)。结论与单纯PA患者比较,PA合并ACS患者年龄及病灶长径更大,且血清皮质醇、血浆ACTH波动幅度更大,临床可根据这些临床特点提前做好筛查与诊断,及时检出合并ACS情况并针对性处理,提高预后。
Objective To investigate the clinical features of primary aldosteronism(PA)complicated by adrenal Cushing syndrome(ACS),and to provide evidence for clinical diagnosis and treatment.Methods Seventy-one patients with PA treated in Henan Armed Police Army General Hospital from June 2017 to June 2022 were selected.They were divided into observation group(16 patients with PA complicated by ACS)and control group(55 patients with PA only)according to whether patients were complicated by ACS.All patients had complete clinical data,and the clinical characteristics of the two groups were compared.Results There was no significant difference in gender,body mass index,comorbidities,and the side of the disease between the two groups(P>0.05),but the patients in the observation group were older,and had longer major diameter of the lesion,compared with the control group(allP<0.05).There was no significant difference in levels of serum potassium,fasting blood glucose,glycosylated hemoglobin,orthostatic renin activity and orthostatic aldosterone between the two groups(P>0.05);however,the serum cortisol level in the observation group was higher than that in the control group at 24∶00 within 1 day(P<0.05),and the plasma adrenocorticotropic hormone(ACTH)level in the observation group was lower than that in the control group at different time points(at 8∶00,16∶00,24∶00)within 1 day(allP<0.05).After 3 months of follow-up,there was no statistically significant difference between the two groups in pathological results,nature of bilateral adrenal lesions,and adrenal cortical insufficiency(P>0.05).Conclusions Compared with patients with PA only,patients with PA complicated by ACS are older,have larger major diameter of lesions,and have greater fluctuations in serum cortisol and plasma ACTH.It is beneficial to improve the prognosis by performing screening and diagnosis based on these clinical features in advance,identifying the complication of ACS,and dealing with them in a targeted manner.
作者
周霖
苏丽婷
程贝贝
李金磊
苗元庆
Zhou Lin;Su Liting;Cheng Beibei;Li Jinlei;Miao Yuanqing(Department of Endocrinology,Henan Armed Police Army General Hospital,Zhengzhou 450000,China)
出处
《中国实用医刊》
2023年第6期15-18,共4页
Chinese Journal of Practical Medicine
