PA低钾型患者血清CK、CK-MB及ARR与血钾的相关性分析

目的探讨原发性醛固酮增多症(PA)低血钾型患者血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB),醛固酮/肾素比值(ARR)与血钾的相关性。方法选取2016年1月至2018年1月在我院治疗的102例PA患者,根据血钾水平将他们分为血钾正常组(血K~+≥3.5mmol/L)和低血钾组(血K+3.5mmol/L),检测两组患者血脂、血糖,血清肌酐(Cr)、CK、CK-MB、立位ARR、卧位ARR等指标。结果 (1)两组患者血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、Cr、葡萄糖(GLU)比较差异无统计学意义(P0.05);低血钾组血清CK、CK-MB、立位ARR、卧位ARR明显高于血钾正常组,差异有统计学意义(P0.05)。(2)血钾正常组患者血清CK、CK-MB,立位ARR、卧位ARR与血钾无显著相关性(P0.05)。低血钾组患者CK、CK-MB,立位ARR、卧位ARR与血钾水平呈显著负相关(r=-0.433、-0.428、-0.389和-0.400,P0.05)。结论PA低钾型患者血清CK、CK-MB,立位、卧位ARR明显升高,且这些指标与患者血钾水平有一定相关性。     

原发性醛固酮增多症100例临床报告

原发性醛固酮增多症(PA),简称原醛,是由于肾上腺皮质病变导致醛固酮分泌增多,负反馈抑制肾素分泌,临床常常表现为高血压、低血钾、高醛固酮、低肾素活性。约占所有高血压人群的1%[1],而在难治性高血压中可达20%[2,3]。醛固酮瘤(APA)和特发性醛固酮增多症(IHA)是PA最常见的两种亚型。以往很多高血压病患者因顽固性血压升高而被误诊为原发性高血压,常规给予降压药治疗,使得血压持久不降,最终致心脑血管疾病发生发展。近     

老年原发性醛固酮增多症误诊为原发性高血压

目的探讨老年原发性醛固酮增多症(primary aldosteronism,PA)的临床特点、误诊原因及防范措施,提高临床诊断率。方法对我病区2010年8月—2013年10月收治的4例误诊为原发性高血压的老年PA的临床资料进行回顾性分析。结果 4例均血压升高,3例服用降压药物血压控制不良,2例出现低血钾,均误诊为原发性高血压,误诊时间5～34年。4例皆行肾上腺CT增强检查示肾上腺瘤,诊断PA,均行肾上腺切除术,术后病理检查均证实为肾上腺醛固酮瘤,给予醛固酮拮抗剂联合扩血管、降血压药物治疗,血压控制良好,血钾正常。结论 PA极易误诊为原发性高血压,早期确诊并治疗,利于病情转归,并可减少严重并发症发生。     

8例原发性醛固酮增多症临床护理体会

目的探讨原发性醛固酮增多症(PA)患者的临床疗效和护理方法。方法总结8例PA患者的临床资料,并对相关护理方法和体会进行分析。结果 8例患者中,4例行手术治疗,术后血压恢复正常。其余4例口服降压药物治疗,血压能基本控制达标,血钾恢复正常。结论 PA患者易发生高血压和低血钾,加强护理可较好控制其血压,及早预防心、脑血管事件的发生,提高生活质量。     

原发性醛固酮增多症患者肾丢钾的标准

原发性醛固酮增多症是少数几个可以治愈的高血压疾患之一,临床表现:高血压、低血钾、肾功能正常的肾丢钾、低肾素高醛固酮血症。当血清钾<3.5mmol/L时,肾丢钾的标准在权威书刊各不相同,有>25mmol/d,>25mmol/L,>30mmol/L,>40mmol/d,给临床应用带来困惑。本文收集近年来我院经手术证实的16例原发性醛固酮增多症患者尿钾排泄量,结合文献提出原发性醛固酮增多症肾丢钾的标准。 1 临床资料 住院患者16例,年龄24～45岁,病程2个月～20年。血清钾及尿钾测定用自动生化仪(Beckman,ELISE)。患者均正常饮食,未用任何影响血钾及尿钾排泄     

原发性醛固酮增多症诊治分析

目的 探讨原发性醛固酮增多症的诊断及治疗.方法 回顾性分析68例原发性醛固酮增多症患者的临床资料.结果 全部患者均有不同程度的低血钾,卧、立位血浆醛固酮平均值分别为(682±332)pmol/L、(881±406)pmol/L,29例患者尿醛固酮值升高,其中48例立位的醛固酮/肾素活性比值≥50.通过影像学检查62例为原发性醛固酮增多症腺瘤型,其余6例为双侧肾上腺增生;32例予以手术治疗,24例予以口服安体舒通治疗,经治疗后56例患者血压及血钾均有不同程度的恢复.结论 原发性醛固酮增多症主要通过影像学检查定位,血、尿醛固酮测定定性诊断.肾上腺腺瘤切除仍是当前的首选治疗方法,安体舒通也是重要的治疗手段.     

原发性醛固酮增多症患者临床特点分析与研究

目的研究原发性醛固酮增多症患者临床表现特点,并对相关特点进行比较与分析。方法 58例确诊原发性醛固酮增多症患者,按照血钾水平分组,正常组16例为正常血钾;低钾组42例为低血钾或存在低血钾病史。比较与分析两组临床生化检测指标和合并症及肾上腺CT检查等。结果两组患者年龄、血压、病程比较差异无统计学意义(P0.05);低钾组男性患者比率、肌酐(Cr)水平均大于正常组,差异有统计学意义(P0.05)。两组患者肾素活性(PRA)、餐后2 h血糖、肾小球滤过率(GFR)、空腹血糖和LDL-C水平比较差异无统计学意义(P0.05);低钾组立位血醛固酮、联合降压药物使用量、24 h尿蛋白、尿K+、三酰甘油和24 h尿醛固酮高于正常组,血K+水平均低于正常组(P0.05)。两组患者心脑血管和糖脂代谢疾病发生率及颈动脉内膜厚度(IMT)、左心室质量指数(LVMI)、颈动脉粥样斑块、左心室肥厚发生率比较差异无统计学意义(P0.05)。经肾上腺CT检查,低钾组腺瘤发生率高于正常组,皮质增生发生率低于正常组(P0.05)。结论原发性醛固酮增多症男性患者易发生低血钾,低血钾原发性醛固酮增多症患者较正常血钾原发性醛固酮增多症患者血压、血脂、血糖均升高,而低血钾患者主要以肾上腺瘤样为主,正常血钾原发性醛固酮增多症患者以肾上腺皮质增生为主,低血钾原发性醛固酮增多症患者并不增加心脑血管疾病发病率。     

原发性醛固酮增多症17例分析

原发性醛固酮增多症 (primary aidosteronism,PA)是继发性高血压的病因之一 ,主要表现为高血压和低血钾 ,有些患者因起病初期仅有高血压而无低血钾表现 ,常易误诊为高血压病而延误治疗。我院 1985～ 1999年收治原发性醛固酮增多症的患者 17例 ,现报告如下。1　临床资料1.1　一般资料　本组男 12例 ,女 5例 ,年龄 2 8～ 6 5岁 ,平均44 .5岁 ,6 0岁以上 1例。病程 1个月～ 2 0 a,平均 5 .45 a。均有高血压病史 ,血压波动在 16 0～ 2 2 0 / 110～ 130 mm Hg,高血压起病年龄早且程度高 ,一般降压药治疗效果经补钾后缓解 ;10例(5 8.8% )有多饮…     

原发性醛固酮增多症26例诊治分析

原发性醛固酮增多症(primary aldosteronism,PA)是指以高血压、低血钾、血浆肾素活性降低、血浆醛固酮浓度增高为特征的临床综合征。PA曾被认为是一种罕见的疾病,但近年来随着诊断技术的改进和提高,PA的病例数逐渐增多。PA的临床表现虽以高血压、低血钾多见,但是某     

四川地区汉族不同亚型原发性醛固酮增多症临床特点分析

目的探讨四川地区不同亚型原发性醛固酮增多症(PA)患者临床特点。方法对2017年1月至2021年1月四川省人民医院内分泌科确诊的131例四川地区汉族PA患者的临床资料进行回顾性分析,通过肾上腺影像学、双侧肾上腺静脉采血、术后病理分型为醛固酮瘤(APA)组32例、特发性醛固酮增多症组(IHA) 22例和原发性肾上腺皮质增生组(PAH) 8例。比较三组的临床特征。结果 (1)131例PA患者确诊时中位年龄52岁,高血压病程中位时间4年,合并低钾血症率为67.18%,合并糖代谢异常率为35.88%;(2)APA组发病年龄最年轻,且好发于女性,相较于IHA组,APA组患者的血钠、尿微量白蛋白/尿肌酐比值、立位醛固酮(PAC)、立位醛固酮/肾素直接浓度比值、生理盐水负荷试验及卡托普利抑制试验前后PAC水平更高,而血钾、血钙、血总蛋白、血白蛋白、血尿酸水平更低(P<0.05)。结论四川地区汉族PA患者好发于中年女性,且低钾血症发生率总体高于国外研究报道。不同亚型PA患者的临床表现存在一定差异性,其中APA患者更年轻,合并更显著的电解质紊乱、早期微量白蛋白尿、高醛固酮血症及高血容量临床特点。     

Low-dose diuretic therapy for hypertension

The efficacy of low dosages of diuretics was evaluated in two studies. In one, 62 (48%) of 130 patients became normotensive with 2.5 mg/day of metolazone. In the other, 28 (49%) of 57 patients became normotensive with 25 mg of chlorthalidone, compared with 12 (22%) of 55 patients given placebo. There was a marked variation in blood pressure response and the occurrence of hypokalemia (less than 3.5 mEq/L of potassium) from center to center and within patient groups in both studies. The mean decrease in serum potassium was between 0.5 and 0.6 mEq/L in the metolazone group and 0.44 mEq/L in the chlorthalidone-treated patients. This degree of hypokalemia is only slightly less than that noted when larger dosages of thiazide diuretics are used (0.6 to 0.7 mEq/L). It is concluded that 2.5 mg/day of metolazone or 25 mg/day of chlorthalidone are effective antihypertensive agents but that blood pressure lowering may be inconsistent at these dosage levels. It is reasonable, therefore, to begin diuretic therapy with low dosages, but larger dosages (5 mg of metolazone or 50 mg of chlorthalidone) should be tried before adding another drug or concluding that diuretic therapy is ineffective if an acceptable blood pressure response is not obtained. The degree of hypokalemia that occurs at lower-dose therapy is variable but may be of less clinical significance than that noted with higher dosages of diuretics in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Potential Usefulness of Early Potassium Supplementation for Preventing Severe Hypokalemia Induced by Liposomal Amphotericin B in Hematologic Patients: A Retrospective Study

Purpose

Liposomal amphotericin B (L-AMB) is an essential antifungal agent for patients with hematologic diseases; however, the drug causes severe hypokalemia at a high frequency. Meanwhile, there is little evidence regarding the risk factors for L-AMB–induced severe hypokalemia, and the prevention protocol has not been established. The goal of this study was to identify the risk factors related to severe hypokalemia induced by L-AMB in hematologic patients.

Insulin dose versus rate of potassium decrease in the treatment of hyperkalemia with iv insulin during extracorporeal circulation: An observational study

Background: Glucose-insulin infusion can be used in the treatment of hyperkalemia occurring during extracorporeal circulation (ECC) in patients undergoing cardiac surgery.Objective: The purpose of this observational study was to investigate the effects of 2 different insulin doses administered during ECC on the rate of decrease in serum potassium level and the incidences of hypokalemia and hypoglycemia in hyperkalemic patients.Methods: Hyperkalemic patients in whom continuous retrograde warmblood cardioplegia was used were enrolled. Patients were assigned to 1 of 2 groups based on serum potassium level (?7 mmol/L, group 1; 6-6.9 mmol/L, group 2). Fifty international units of crystallized human insulin was given IV as a bolus dose to group 1 and 25 IU to group 2. The rate of decrease in serum potassium level was recorded, the time required for the level to decrease to 5.5 mmol/L after insulin injection was recorded, and patients were monitored for hypokalemia and hypoglycemia.Results: Thirty-six patients (24 males, 12 females; mean age, 52.5 years) were enrolled. The mean time required for the serum potassium level to decrease to 5.5 mmol/L after insulin injection was 22.7 ± 1.9 minutes in group 1 and 15.7 ± 0.8 minutes in group 2. During this interval, the mean decreases and the mean rate of decrease in serum potassium level were as follows: group 1, 1.78 mmol/L and 0.078 mmol/L per minute, respectively; group 2, 0.076 mmol/L and 0.0048 mmol/L per minute, respectively. The incidences of hypokalemia and hypoglycemia were significantly higher in group 1 than in group 2.Conclusions: In this study population, the serum potassium level needed for discontinuation of ECC was achieved more rapidly with insulin 50 IU than with insulin 25 IU, but with higher incidences of hypokalemia and hypoglycemia.     

依据CLSI EP07-A3文件评价血清指数对免疫散射比浊法检测前白蛋白的干扰

目的 探讨溶血、黄疸、脂浊对免疫散射比浊法检测前白蛋白(PA)的干扰效果.方法 以新鲜血清样本作为基础样本,添加干扰物[血红蛋白(Hb)、胆红素及脂质]后,采用免疫散射比浊法检测PA水平.参考美国临床实验室标准化协会(CLSI)EP07-A3文件进行配对差异实验、剂量效应实验.结果 10 g/L Hb(溶血指数为100...     

Effect of Bilateral Stellectomy on Electrical Instability of the Atrium in the Dog with Hypokalemia

To investigate the effect of sympathetic nerve activity on electrical instability of the atrium in the presence of hypokalemia, open chest electrophysiological study was performed before and after bilateral stellectomy (BS) in 15 dogs with hypokalemia (hypokalemia group) and in 15 dogs with normokalemia (control group). Hypokalemia was created by infusion of 5.0 g/kg of polystyrene sulfonic acid calcium into the colon. Serum level of potassium was significantly lower in the hypokalemia group (2.94 +/- 0.52 mEq/L) than in the control group (4.86 +/- 0.51 mEq/L, P less than 0.01) before BS. There was no significant change in serum level of potassium in the two groups after BS. Incidence of electrically induced atrial fibrillation (AF) was significantly higher in the hypokalemia group (80%) than in the control group (13%, P less than 0.001) before BS. It was significantly reduced in the hypokalemia group (40%, P less than 0.05), but not in the control group (6%) after BS. Dispersion of effective refractory period of the atrium (delta ERP) was significantly greater in the hypokalemia group (26.1 +/- 2.8 msec) than in the control group (22.0 +/- 3.3 msec, P less than 0.005) before BS. It was significantly decreased to 23.1 +/- 3.2 msec in the hypokalemia group (P less than 0.001) and to 20.6 +/- 2.5 msec in the control group (P less than 0.01) after BS. Maximum conduction delay in the atrium (MaxCD) was 36.1 +/- 3.5 msec before and 36.2 +/- 4.1 msec after BS in the hypokalemia group and 31.1 +/- 4.2 msec before and 32.3 +/- 4.9 msec after BS in the control group. There was a significant difference in MaxCD between the two groups before BS. Atrial fibrillation threshold (AFT) was significantly lower in the hypokalemia group (3.9 +/- 0.7 mA) than in the control group (13.8 +/- 3.1 mA, P less than 0.001) before BS. It was significantly increased both in the hypokalemia group (6.5 +/- 1.3 mA, P less than 0.001) and in the control group (15.0 +/- 2.7 mA, P less than 0.005) after BS. It is concluded that sympathetic nerve activity may play some role in the increase in electrical instability of the atrium in the presence of hypokalemia.     

急性心肌梗死早期低血钾与心衰的关系

目的 探讨急性心肌梗死（AMI）患者早期低钾血症的变化以及与心力衰竭的关系。方法收集200例急性心肌梗死的患者,发病时间小于24小时,所有患者均为首次入院。根据血钾浓度分为低钾血症组和正常血钾组,其中低钾血症组又分为重度低钾组（〈2．50mmol／L）、中度低钾组（2．51mmol／L-3．0mmool／L）和轻度低钾组（3．01-3．50mmol／L）。所有患者予以常规积极治疗,观察心力衰竭发生情况。结果AMI患者低钾血症的发生率为73．5％,低钾血症组心力衰竭的发生率为51．7％,明显高于正常组（22．6％）,其中重度低钾组心衰的发生率78．2％,中度低钾组为58．3％,轻度低钾组为38．9％。结论急性心肌梗死早期易出现低钾血症,并且随着血钾浓度的降低,心力衰竭的发生率也明显增高。     

肿瘤相关性贫血铁代谢及前白蛋白水平变化的临床意义

目的 分析实体肿瘤患者贫血发生情况、贫血类型、铁代谢状况、前白蛋白水平的变化情况及其之间的相关性.方法 对2007年7月至2010年4月期间我院收治的370例恶性实体肿瘤患者的临床资料进行回顾性分析.结果 370例肿瘤患者中有206例存在贫血,发生率55.67%(206/370),其中轻度贫血129例,中、重度贫血77例,后者血清铁明显降低[(8.37±6.09)μmol/L];血清铁蛋白增高[(474.57±327.58)μg/L];血清铁降低与贫血程度有相关性(P＜0.05),而不同程度贫血之间血清铁蛋白差异无统计学意义(P＞0.05);所有贫血患者中,前白蛋白下降187例(90.77%),贫血下降的程度与前白蛋白下降未显示有相关性(P＞0.05).结论 恶性实体肿瘤患者贫血发生率较高,而且以正细胞正色素性贫血为主,与铁代谢障碍有关,与前白蛋白水平无相关性.

Abstract：

Objective To explore the occurrence of anemia, anaemia type, iron metabolism situation,variation of serum Prealbumin (PA), and the relationship among them in cancer patients. Methods Three hundred and seventy cancer patients, admitted from July 2007 to April 2010 to our hospital, were enrolled into the study. The clinical data of all subjects were analyzed retrospectively. Results The incidence of anemia in 370 patients was 55.67% (206/370). Among all 206 anemia cases,129 cases had mild anaemia and 77 cases had middle to severe anaemia. In the last group ( n = 77 ), we found significant decrease in serum iron level ( [ 8. 37 ± 6. 09 ] μmol/L) and increase in serum ferritin level ( [ 474. 57 ± 327. 58 ] μg/L); and the correlation between serum iron and the anemia degree( Ps ＜ 0. 05 ). However, we found no significant differences of serum ferritin level between the groups with different degree of anemia(P ＞0. 05). Among all 206 anemia cases ,187(90. 77% ) patients had a low level of serum PA, but no relationship between the degree of anemia and the drop of serum PA ( P ＞ 0. 05 ). Conclusion The anemia was very popular in cancer patients, which had correlation with iron metabolism situation but not PA.     

Plasma exchange in refsum's disease: Case report and review of the literature

Refsum's disease is characterized by the accumulation of phytanic acid (PA). Some clinical features are directly related to serum PA and may therefore improve with plasma exchange (PE). We present a patient with severe polyneuropathy and PA of 1809 mg/L, exacerbated by weight loss of 15 kg. Clinical improvement occurred only when PA fell to 500 mg/L after intensive PE and a high calorie liquid diet. This accords with published reports of severely ill patients which indicate that PE is only effective when combined with dietary control and arrest of weight loss. PE is of questionable value in less severely ill patients with PA < 500 mg/L.