原发性醛固酮增多症高血压临床特点的研究

为研究原发性醛固酮增多症 (醛固酮瘤型 )高血压的临床特点 ,回顾性分析了本院 1985～ 2 0 0 2年 10月经病理明确诊断的醛固酮瘤 112例 ,其中单侧腺瘤 111例 ,双侧腺瘤 1例。结果发现 ,醛固酮瘤的高血压患病率为 10 0 % ,其中 1级 14 3% ,2级 37 5 % ,3级4 8 2 % ;高血压病程 1个月～ 2 1年 ,平均 5 5年 ;肿瘤直径为 1～ 5cm(2 1± 0 7cm) ;血压与术前年龄、病程和肿瘤大小均没有相关性 ;高血压血管并发症患病率为 31 3% ,其中脑卒中 4 5 % ,心肌梗死 1 8% ,蛋白尿 2 2 3% ,肾功能不全 2 7% ;血管并发症发生与否同高血压病程、肿瘤大小、最高收缩压和舒张压无关 ;术前 83 9% (94 / 112 )的患者服用降压药物 ,其中 6 3 8% (6 0 / 94 )应用 2种以上降压药物 ;醛固酮瘤摘除术后 2周内 5 3 6 % (6 0 / 112 )的患者血压恢复正常 ,4 6 5 % (5 2 / 112 )仍为持续性高血压 ,其中 88 5 % (4 6 / 5 2 )和 11 5 % (6 / 5 2 )的患者分别为 1期和 2期高血压。说明醛固酮瘤的高血压患病率高 ,且多为中重度高血压 ;其高血压血管并发症以蛋白尿和脑卒中常见 ;术前高血压难以用药物控制 ,术后仍有部分患者存在持续性高血压

STUDY ON CLINICAL CHARACTERISTICS OF HYPERTENSION IN PATIENTS WITH PRIMARY ALDOSTERONISM

To investigate the clinical characteristics of hypertension in patients with primary aldosteronism (PA), 112 cases of PA confirmed by pathological examination after operation were studied retrospectively. These included 111 cases of PA with unilateral adrenal adenoma and 1 case of bilateral adrenal adenoma. Incidence of hypertension in patients with PA was 100%. 14 3%, 37 5% and 48 2% of patients were at stage 1, 2 and 3 of hypertension, respectively. No relationship between hypertension and the age or duration of hypertension and the size of tumor. Complications of hypertension were found in 31 3% of patients with PA. Stroke was found in 4 5% patients, 3 6% patients with cerebral hemorrhage and 0 9% patients with cerebral infarction. Coronary artery disease as myocardial infarction was found in 1 8% of patients. Proteinuria and renal insufficiency were found in 22 3% of patients and 2 7% of patients, respectively. Complications of hypertension were independent of the age, duration of hypertension, the size of tumor, or preoperative highest systolic pressure and diastolic pressure. 83 9% of patients had taken antihypertensive drugs before operation, and 46 5% of patients still had persistent hypertension after operation. The results suggested that the incidence of hypertension in patients with PA was extremely high, and the majority of patients were suffering from moderate and severe hypertension. Complications of hypertension were common in patients with PA. Hypertension was difficult to control by using antihypertensive drugs before operation, and still persisted after operation in some of the patients with PA.