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目的探讨醛固酮瘤(APA)患者高血糖患病率及其术后变化。方法检测APA组血压、血醛固酮(S-Ald)、尿醛固酮(U-Ald)、血浆肾素活性(PRA)基础和激发值,与原发性高血压(EH)和对照组比较。APA组行肾上腺肿瘤摘除术后随访激素及糖代谢指标,与术前比较。结果 APA组葡萄糖及胰岛素曲线下面积(AUCg,AUCi)高于EH、对照组,胰岛素抵抗指数(HOMA-IR)高于对照组。APA组高血糖者44.6%,高于EH、对照组。根据OGTT结果将APA组分为APA合并高血糖(A)亚组和APA未合并高血糖(B)亚组,A亚组S-Ald高于B亚组。APA患者08:00S-Ald与2hPG、AUCg呈正相关,血钾与2hPG、AUCg呈负相关。APA组术后S-Ald、U-Ald、FPG、2hPG、AUCg及AUCi均较术前下降,血钾升高。术后患者高血糖患病率35.4%。结论 APA患者高血糖患病率升高,其原因与醛固酮高分泌有关。
Objective To investigate the prevalence and postoperative changes of hyperglycemia in patients with aldosterone tumor (APA). Methods Blood pressure, serum aldosterone (S-Ald), urinary aldosterone (U-Ald) and plasma renin activity (PRA) basal and excitation values in APA group were compared with those in essential hypertension (EH) and control group. APA group were followed up for hormone and glucose metabolism indexes after adrenalectomy, compared with preoperative. Results The area under the curve of glucose and insulin (AUCg, AUCi) in APA group was higher than that in EH group. The control group and insulin resistance index (HOMA-IR) were higher than those in control group. APA group 44.6% of hyperglycemia, higher than EH, control group. According to OGTT results, APA was divided into APA combined with hyperglycemia (A) subgroup and APA without hyperglycemia (B) subgroup, S group A was higher than subgroup B. APA patients 08: 00S-Ald and 2hPG, AUCg was positively correlated, serum potassium and 2hPG, AUCg was negatively correlated. In the APA group, the postoperative S-Ald, U-Ald, FPG, 2hPG, AUCg and AUCi decreased compared with preoperative, and the serum potassium increased. Postoperative patients the prevalence of hyperglycemia 35.4%. Conclusions The prevalence of hyperglycemia in patients with APA is elevated due to hyperaldcretion of aldosterone.