CAJ | 학술논문

目的：探讨肾上腺增生性高血压单侧肾上腺切除术后高血压复发的影响因素。方法回顾性分析南方医科大学附属江门医院自2004年1月至2012年2月期间68例接受单侧肾上腺切除手术治疗的单侧肾上腺增生高血压患者的临床资料。对患者的一般资料进行收集整理，对患者术后血压、症状进行随访。统计分析肾上腺增生性高血压单侧肾上腺切除术后高血压复发的影响因素。结果68例单侧肾上腺增生性高血压患者行患侧肾上腺切除，术后血压正常。在6个月后的随访中（随访时间47.2±5.9个月），有25例（36.8%）患者血压再次升高或再次需要口服药物控制血压。在影响手术疗效变量的单因素分析中，年龄、术后收缩压水平、高血压病程、肾上腺增生类型有统计学意义（P<0.05）。在对以年龄、性别、体重指数、手术侧别、高血压病程、肾上腺增生类型、术前血钾、术后收缩压水平、皮质醇节律、血浆醛固酮肾素比、尿儿茶酚胺代谢物水平等作为自变量的多因素Logistic回归分析中，影响术后高血压复发的因素有年龄>50岁，高血压病程>5年，肾上腺增生类型为皮髓质增生。结论单侧肾上腺切除对于治疗肾上腺增生性高血压是安全、有效的。术后影响高血压复发的主要因素有高龄（年龄>50岁）、长病程（>5年）、皮髓质增生类型，可为肾上腺增生性高血压患者手术预后评估提供依据。
목적：탐토신상선증생성고혈압단측신상선절제술후고혈압복발적영향인소。방법회고성분석남방의과대학부속강문의원자2004년1월지2012년2월기간68례접수단측신상선절제수술치료적단측신상선증생고혈압환자적림상자료。대환자적일반자료진행수집정리，대환자술후혈압、증상진행수방。통계분석신상선증생성고혈압단측신상선절제술후고혈압복발적영향인소。결과68례단측신상선증생성고혈압환자행환측신상선절제，술후혈압정상。재6개월후적수방중（수방시간47.2±5.9개월），유25례（36.8%）환자혈압재차승고혹재차수요구복약물공제혈압。재영향수술료효변량적단인소분석중，년령、술후수축압수평、고혈압병정、신상선증생류형유통계학의의（P<0.05）。재대이년령、성별、체중지수、수술측별、고혈압병정、신상선증생류형、술전혈갑、술후수축압수평、피질순절률、혈장철고동신소비、뇨인다분알대사물수평등작위자변량적다인소Logistic회귀분석중，영향술후고혈압복발적인소유년령>50세，고혈압병정>5년，신상선증생류형위피수질증생。결론단측신상선절제대우치료신상선증생성고혈압시안전、유효적。술후영향고혈압복발적주요인소유고령（년령>50세）、장병정（>5년）、피수질증생류형，가위신상선증생성고혈압환자수술예후평고제공의거。
Objective To evaluate the influence factors for recurrent hypertension in patients with adrenal hyperplasia after unilateral adrenalectomy. Methods From January 2004 to February 2012, a total of 68 patients with adrenal hyperplasia underwent unilateral adrenalectomy were included. Clinical and biochemical data were reviewed retrospectively. We followed up all the patients to collect the recovery of blood pressure and the improvement of clinical symptoms data after adrenalectomy, after a follow-up time of (47.2±5.9) months. We analyzed the influence factors for recurrent hypertension in patients with adrenal hyperplasia after adrenalectomy. Results The blood pressure was normalized in 68 patients in 6 months after surgery. After a follow-up time of (47.2±5.9) months, 25 of 68 patients had recurrent hypertension. In the univariate analysis of outcome, age, postoperative systolic blood pressure, duration of hypertension and pathological types were significant differences between patients with recurrent hypertension and the rest patients (P<0.05). Multivariate regression analysis revealed that age (more than 50 years old), duration of hypertension (more than 5 years), the presence of adrenal cortical and medullary hyperplasia were the main determinants of recurrent hypertension after unilateral adrenalectomy. Conclusion Adrenalectomy for the treatment of unilateral adrenal hyperplasia hypertension is safe and effective. Age (more than 50 years old), duration of hypertension (more than 5 years), and the presence of adrenal cortical and medullary hyperplasia are the influence factors for recurrent hypertension in patients with adrenal hyperplasia after adrenalectomy, which could provide the theoretical basis for adrenal hyperplasia hypertension after unilateral adrenalectomy.