醛固酮瘤患者动态血压特点及相关因素分析

目的探讨醛固酮瘤患者血压昼夜节律特点。方法对2010年1月至2012年12月收治的20例醛固酮瘤（APA）患者（APA组）、25例原发性高血压（EH）患者（EH组），行24h动态血胝监测，评价APA患者全天血压变化，分析APA患者血压昼夜节律特点和影响因素。结果APA组BMI、血清钾水平、立位肾素活性、血管紧张素Ⅱ水平低于EH组，而血清钠、立位醛吲酮水平高于EH组，差异有统计学意义（t值分别为-2．31、-5．68、-4．39、-2．43、2．72和2．79，均P〈0．05）。APA组夜间平均收缩压高于EH组[（140±20）与（126±19）mmHg（1mmHg=0．133kPa），t=2．32，P〈0．05]，两组平均血压、血压变异性指标、夜间血压下降幅度与百分率差异均无统计学意义（P〉0．05）。两组患者杓形血压的比例差异无统计学意义[20％（4／20）与28％（7／25），X^2=1．43，P〉0．05]。以性别、年龄、高血压病程、高血压家族史、BMI、血清钠水平、血清钾水平、立位血浆醛㈨酮及肾素水平为白变量，以杓形血压作为因变量进行多元logistic回归分析，上述指标与非杓形血压无独立相关性。结论APA患者发生昼夜血压节律消失的比例以及高血压特点与EH患者之间无明显的差蚌。

Circadian blood pressure pattern in patients with aldosterone-producing adenoma and its associatedfactors

Objective To investigate the circadian blood pressure pattern in patients with aldosterone-producing adenoma. Methods Circadian variation of blood pressure was assessed by 24-h ambulatory bluod pressure monitoring （ABPM） in 20 patients with adrenal aldosterone-produeing adenoma （APA） and 25 patients with essential hypertension （EH）. Results Compared to EH group, the body mass index, serum potassium concentration, upright plasma renin activity and angiotensin Ⅱ levels in APA group were lower and the serum sodium concentration and upright plasma aldosterone concentration were higher （ all P 〈 0. 05）. The night-time systolic blood pressure in APA group was higher than that in EH group [ （ 140±20） vs. （ 126±19） mm Hg（ 1 mm Hg = 0. 133 kPa）, t = 2. 32, P 〈 0.05] ; there were no differences in day-night blood pressure differences between patients with APA and those with EH. Proportions of patients with dipper blood pressure were also comparable between the two groups [ 20% （4/20） vs. 28% （7/25）, X^2 = 1.43, P 〉 0.05]. Muhivariate Logistic regression analysis showed no independent predictors for non- dipper circadian blood pressure pattern. Conclusion There are no significant differences in proportion of non- dipper eircadian blood pressure pattern and blood pressure c, haracteristics between APA and EH patients.