上海交通大学学报（医学版）

›› 2010, Vol. 30 ›› Issue (5): 493-.

• 专题报道（肾上腺疾病） • 上一篇    下一篇

原发性醛固酮增多症患者糖脂代谢特征及相关因素分析

叶 菲, 汤正义, 吴景程, 杨 洋, 田秀丽, 黄佳佳, 徐 茜, 张杉杉, 李小英, 王卫庆, 宁 光   

  1. 上海交通大学 医学院瑞金医院内分泌代谢病科 上海市内分泌代谢病科研究所 上海市内分泌代谢病临床医学中心, 上海 200025
  • 出版日期:2010-05-25 发布日期:2010-05-28
  • 通讯作者: 汤正义, 电子信箱: tsy2zyp@163.com。
  • 作者简介:叶 菲（1986—）, 女, 住院医师, 硕士；电子信箱: y_aichacha@163.com；现在上海长征医院内分泌代谢病科工作（200003）。

Characteristics of glucolipid metabolism and analysis of related factors in patients with primary aldosteronism

YE Fei, TANG Zheng-yi, WU Jing-cheng, YANG Yang, TIAN Xiu-li, HUANG Jia-jia, XU Qian, ZHANG Shan-shan, LI Xiao-ying, WANG Wei-qing, NING Guang   

  1. Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrinology and Metabolism, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
  • Online:2010-05-25 Published:2010-05-28

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摘要：

目的 探讨原发性醛固酮增多症（原醛症）患者糖脂代谢特征及其相关因素分析。方法 299例原醛症患者分为醛固酮瘤组（APA组，n=103）、单侧结节性肾上腺增生组（UNAH组，n=52）和双侧肾上腺增生组（BAH组，n=144），以100例原发性高血压患者作为对照组。收集各组患者的临床资料，对糖脂代谢相关指标进行组间比较；同时就原醛症患者血尿醛固酮水平与糖脂代谢指标进行相关性分析。结果 与对照组比较，原醛症患者餐后30 min和60 min血糖值及血清三酰甘油和总胆固醇水平均显著降低（P<0.01），血清高密度脂蛋白水平显著升高（P<0.01）。原醛症患者中，APA组餐后60、120 min血糖和餐后60、120、180 min血清胰岛素水平以及血清三酰甘油水平显著低于BAH组（P<0.05），而高密度脂蛋白水平显著高于BAH组（P<0.05）。相关性分析表明，原醛症患者糖脂代谢指标与24 h尿醛固酮及血基础醛固酮水平呈显著负相关（P<0.05）；脂代谢异常与患者原醛症病程呈显著正相关（P<0.05）。结论 与原发性高血压患者相比，原醛症患者糖脂代谢异常程度较轻。在原醛症亚型中，BAH患者糖脂代谢异常较为明显，其严重程度与患者病程有关。

关键词: 原发性醛固酮增多症, 糖代谢, 脂代谢, 病程

Abstract:

Objective To investigate the characteristics of glucolipid metabolism in patients with primary aldosteronism, and explore the related factors. Methods Two hundred and ninety-nine patients with primary aldosteronism were classified into aldosterone producing adenoma group (APA group, n=103), unilateral nodular adrenal hyperplasia group (UNAH group, n=52) and bilateral adrenal hyperplasia group (BAH group, n=144). Besides, another 100 patients with essential hypertension were served as control group. The clinical data of patients in each group were collected, and the parameters related to glucolipid metabolism were compared among groups. Meanwhile, correlation analysis was conducted between levels of serum and urine aldosterone and glucolipid metabolic parameters in patients with primary aldosteronism. Results Compared with control group, the levels of post-prandial 30 min and 60 min blood glucose, serum triglyceride and total cholesterol in patients with primary aldosteronism were significantly lower (P<0.01), and the level of serum high density lipoprotein was significantly higher (P<0.01). The levels of postprandial 60 min and 120 min blood glucose, post-prandial 60 min, 120 min and 180 min serum insulin and serum triglyceride in APA group were significantly lower than those in BAH group (P<0.05), while the level of high density lipoprotein in APA group was significantly higher than that in BAH group (P<0.05). Correlation analysis revealed that parameters of glucolipid metabolism were significantly negatively correlated with levels of 24 h urine aldosterone and serum baseline aldosterone in patients with primary aldosteronism (P<0.05), and the abnormality of lipid metabolism was significantly positively correlated with duration of disease in patients with primary aldosteronism (P<0.05). Conclusion Abnormalities of glucose and lipid metabolism in patients with primary aldosteronism were less severe than those in patients with essential hypertension. Among the subtypes of primary aldosteronism, the abnormalities of glucose and lipid metabolism of BAH were more severe, and the abnormalities are related with the duration of disease.

Key words: primary aldosterone, glucose metabolism, lipid metabolism, duration of disease