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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30min和60min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、120min血糖和餐后60、120、180min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24h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。
Objective To investigate the characteristics of glycometabolism and its related factors in patients with primary aldosteronism (primary aldosteronism). Methods 299 primary aldosteronism patients were divided into aldosterone group (n = 103 in APA group), unilateral nodular adrenal hyperplasia group (n = 52 in UNAH group) and bilateral adrenal hyperplasia group (n = 144 in BAH group) ), With 100 cases of essential hypertension as a control group. The clinical data of patients in each group were collected to compare the indexes related to glucose and lipid metabolism. Meanwhile, the correlation between serum aldosterone level and glucose and lipid metabolism was analyzed. Results Compared with the control group, the levels of serum glucose, serum triglyceride and total cholesterol were significantly decreased at 30 and 60 minutes after meal (P <0.01) and the levels of serum high density lipoprotein were significantly increased (P <0.01). In the patients with primary aldosteronism, the blood glucose levels at 60 and 120 minutes after meal and the levels of serum insulin and serum triglyceride at 60,120 and 180 minutes after meal in APA group were significantly lower than those in BAH group (P <0.05), while the levels of HDL were significantly higher In BAH group (P <0.05). Correlation analysis showed that there was a significant negative correlation (P <0.05) between the indicators of glucose and lipid metabolism and the level of urinary aldosterone and blood aldosterone in patients with primary aldosteronism (P <0.05) . Conclusion Compared with patients with essential hypertension, patients with primary aldosteronism less abnormal glucose and lipid metabolism. In the original aldehyde subtype, BAH patients with abnormal glucose and lipid metabolism is more obvious, the severity of the patient’s course.