两型原发性醛固酮增多症患者胰岛素敏感性的比较及其胰岛素敏感性与病情的关系

目的 分析和比较两型原发性醛固酮增多症（PA）患者胰岛素敏感性及其治疗前后胰岛素敏感性与病情的关系。方法 本院确诊PA患者32例，其中肾上腺皮质腺瘤（APA）20例，特发性醛固酮增多症（IHA）12例，观察治疗前后体质量指数、血压、血浆醛固酮、空腹血糖、空腹胰岛素及胰岛素抵抗指数（HOMA-IR）等指标的变化。结果 PA组患者治疗后收缩压［（140±8.6）mmHg］、舒张压［（82±9）mmHg］、空腹胰岛素［（7.6±1.8）mmol/L）］、空腹血糖［（5.0±0.7）mmol/L］、HOMA-IR（1.6±0.4）均低于治疗前［收缩压（178±10）mmHg、舒张压（105±11）mmHg、空腹胰岛素（10±3）mmol/L、空腹血糖（5.6±1.1）mmol/L、HOMA-IR（2.4±0.9）,均P<0.01］；治疗前IHA组血浆醛固酮水平［（228±52）ng/L］低于治疗前APA组［（344±41）ng/L，P<0.01）］；治疗前IHA组胰岛素抵抗患者所占百分率（58%）显著高于APA组（20%，P<0.05）；APA手术组醛固酮水平（82±23）ng/L低于治疗前［(344±41) ng/L,P<0.01）］；治疗后APA组血钾（4.0±0.4）mmol/L、HIA组血钾（4.1±0.4）mmol/L分别较治疗前［（3.2±0.4）mmol/L、（3.4±0.3）mmol/L］高（P<0.01）。结论 PA患者部分存在胰岛素抵抗。PA患者在进行肾上腺腺瘤切除或应用螺内酯治疗后胰岛素敏感性可有一定程度恢复。

Insulin sensitivity in 32 patients with primary aldosteronism

AIM To determine the outcome of insulin sensitivity in patients with primary aldosteronism before and after treatment. METHEDS Of the 32 patients who had been diagnosed as having primary aldosteronism (PA) in 303 Hospital from 2001 to November 2007, 20 case were diagnosed as having aldosterone-producing adenoma (APA) and 12 cases as idiopathic hyperaldosteronism (IHA). BMI, BP, plasma potassium concentration, aldosterone, FBG, fasting INS, and HOMAIR were observed in all the patients. RESULTS The SBP（140±8.6）mmHg, DBP（82±9）mmHg, fasting INS（7.6±1.8）mmol/L, FBG（5.0±0.7）mmol/Land HOMAIR（1.6±0.4） were significantly lower in patients with PA after treatment as compared with those in the same patients before treatment［SBP（178±10）mmHg, DBP（105 ±11）mmHg, fasting INS（10±3）mmol/L, FBG（5.6±1.1）mmol/L and HOMAIR（2.4±0.9） (all P<0.01)］ . Before treatment, the aldosterone (ALD) concentration（228±52）ng/L was significantly lower in patients with IHA as compare with that in the APA group（344±41)ng/L,（P<0.01） and the prevalence of insulin resistance（58%） was significantly higher in patients with IHA than that in patients with APA（20%, P<0.05）. The aldosterone concentration (82±23) ng/L was significantly lower in patients with APA after treatment with surgery than that in the same patients before treatment (301±72)ng/L（P<0.01）. After treatment the plasma potassium concentration was significantly higher in APA group（4.0±0.4）mmol/L and HIA group（4.1±0.4）mmol/Las compare with the same patients before treatment［（3.2±0.4）mmol/L,（3.4±0.3）mmol/L（all P<0.01）］. CONCLUSION SInsulin resistance is present in patients with tumoral and idiopathic aldosteronism. Treatment with surgery or aldosterone antagonists can improve the insulin sensitivity.