CAJ | 학술논문

目的探讨醛固酮瘤患者生化指标的异常及临床特点与腺瘤直径之间的关系.方法回顾性分析1992年至2012年在解放军总医院收治并经病理证实的347例醛固酮瘤患者临床资料,以腺瘤直径2.0 cm作为切点分为2组:A组(直径＜2 cm)和B组(直径≥2 cm),比较2组间的生化和临床特点.结果 (1)347例患者平均年龄(43.8±9.9)岁,病程为(7.5±7.0)年,87.9％(305/347)患者血钾低于正常水平,腺瘤平均直径为(2.0±0.9) cm.与A组比较,B组患者年龄更小[(42.8±9.9对44.9±9.8)岁,P＜0.05],血钾水平更低[(2.7±0.6对2.9±0.5)mmol/L,P＜0.01]；然而,2组间体重指数、性别构成、高血压病程、血压水平、吸烟饮酒史以及高血压家族史等均无明显差异.(2)A组卧位血清醛固酮[637.9(478.6 ～776.9)对693.7(519.1 ～987.5) pmol/L,P＜0.05]及立位血清醛固酮[710.6(532.9 ～ 892.9)对791.7(572.7～1 177.0) pmol/L,P＜0.01]水平均明显低于B组,线性回归分析显示醛固酮瘤直径与卧、立位血清醛固酮水平均呈正相关,与血钾水平呈负相关.(3)2组患者血管并发症总体发生率无明显差异(37.7％对41.9％).进一步分析显示,A组心绞痛事件发生率明显高于B组(7.4％对1.7％,P＜0.05),二分类logistic回归分析显示心绞痛事件仅与年龄相关(OR=0.865,P＜0.05),与腺瘤直径、血醛固酮和血钾水平等无关;2组间左室肥厚、室间隔肥厚、心律失常和心肌梗死等发生率均没有明显差异.脑血管事件和慢性肾功能不全的发生率在2组间相当.(4)术后2周内,53.4％患者的血压和90.0％患者的血钾恢复正常,2组间血压、血钾恢复率相当.结论醛固酮瘤患者腺瘤直径与血清醛固酮及血钾水平明显相关,与高血压病程、血压水平、血管并发症及术后2周时预后无明显相关.
목적 탐토철고동류환자생화지표적이상급림상특점여선류직경지간적관계.방법 회고성분석1992년지2012년재해방군총의원수치병경병리증실적347례철고동류환자림상자료,이선류직경2.0 cm작위절점분위2조:A조(직경＜2 cm)화B조(직경≥2 cm),비교2조간적생화화림상특점.결과 (1)347례환자평균년령(43.8±9.9)세,병정위(7.5±7.0)년,87.9％(305/347)환자혈갑저우정상수평,선류평균직경위(2.0±0.9) cm.여A조비교,B조환자년령경소[(42.8±9.9대44.9±9.8)세,P＜0.05],혈갑수평경저[(2.7±0.6대2.9±0.5)mmol/L,P＜0.01]；연이,2조간체중지수、성별구성、고혈압병정、혈압수평、흡연음주사이급고혈압가족사등균무명현차이.(2)A조와위혈청철고동[637.9(478.6 ～776.9)대693.7(519.1 ～987.5) pmol/L,P＜0.05]급립위혈청철고동[710.6(532.9 ～ 892.9)대791.7(572.7～1 177.0) pmol/L,P＜0.01]수평균명현저우B조,선성회귀분석현시철고동류직경여와、립위혈청철고동수평균정정상관,여혈갑수평정부상관.(3)2조환자혈관병발증총체발생솔무명현차이(37.7％대41.9％).진일보분석현시,A조심교통사건발생솔명현고우B조(7.4％대1.7％,P＜0.05),이분류logistic회귀분석현시심교통사건부여년령상관(OR=0.865,P＜0.05),여선류직경、혈철고동화혈갑수평등무관;2조간좌실비후、실간격비후、심률실상화심기경사등발생솔균몰유명현차이.뇌혈관사건화만성신공능불전적발생솔재2조간상당.(4)술후2주내,53.4％환자적혈압화90.0％환자적혈갑회복정상,2조간혈압、혈갑회복솔상당.결론 철고동류환자선류직경여혈청철고동급혈갑수평명현상관,여고혈압병정、혈압수평、혈관병발증급술후2주시예후무명현상관.
Objective To investigate the biochemical findings and clinical characteristics with regard to the tumor size in patients with aldosterone-producing adenoma (APA).Methods Totally 347 consecutive patients with APA confirmed by pathological diagnosis during 1992 to 2012 in PLA general hospital were included.Patients were divided into two groups according to tumor size with diameter of 2.0 cm as a cutoff:group A(size＜2 cm) and group B (size ≥2 cm),and the clinical features were compared between two groups.Results (1) In 347 patients,the average age was (43.8 ± 9.9) years,disease duration was (7.5 ± 7.0) years,hypokalemia was present in 87.9％(305/347) patients,and the average diameter of adenoma was (2.0 ± 0.9) cm.Compared with group A,patients in group B were younger [(42.8 ± 9.9 vs 44.9 ± 9.8) years,P＜0.05] and had lower serum potassium level [(2.7 ± 0.6vs 2.9 ± 0.5) mmol/L,P＜0.01] ; No significant differences were found in gender,body mass index,duration of illness,family history of hypertension,and habits of smoking and drinking between two groups.(2) Compared with group B,group A showed lower supine aldosterone level [(637.9 (478.6-776.9) vs 693.7 (519.1-987.5) pmol/L,P＜0.05] and standing serum aldosterone level [(710.6 (532.9-892.9) vs 791.7 (572.7-1 177.0) pmol/L,P＜0.01].Linear regression analysis showed that tumor diameter was positively correlated with supine and standing serum aldosterone levels,and was negatively correlated with serum potassium level in APA patients.(3) No significant difference was found in the overall incidence of vascular complications in the two groups of patients (37.7％ vs 41.9％).Further analysis showed that prevalence of angina in group A was significantly higher than group B (7.4％ vs 1.7％,P＜0.05),while the binary logistic regression analysis showed that angina event was only related to age (OR =0.865,P＜0.05),but not related to adenoma size,serum aldosterone or potassium levels.No significant differences were found in the incidences of left ventricular hypertrophy,septal hypertrophy,arrhythmias and myocardial infarction between the two groups.The prevalences of cerebrovascular events and chronic renal insufficiency were equally considerable in two groups.(4) Overall,recovery rates of blood pressure and serum potassium level two weeks after operation were 53.4％ and 90.0％ respectively,both similar between the two groups.Conclusion Adenoma size in APA patients was significantly related to serum aldosterone and serum potassium levels,but not significantly related to duration of hypertension,blood pressure,and vascular complications,as well as the prognosis in 2 weeks after surgery.