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刘虹蝶, 李元美, 王雯, 等. 四川大学华西医院2009−2018年原发性醛固酮增多症临床诊断治疗分析[J]. 四川大学学报(医学版), 2020, 51(3): 292-297. DOI: 10.12182/20200360108
引用本文: 刘虹蝶, 李元美, 王雯, 等. 四川大学华西医院2009−2018年原发性醛固酮增多症临床诊断治疗分析[J]. 四川大学学报(医学版), 2020, 51(3): 292-297. DOI: 10.12182/20200360108
LIU Hong-die, LI Yuan-mei, WANG Wen, et al. Diagnosis and Treatment of Primary Aldosteronism in West China Hospital of Sichuan University from 2009 to 2018[J]. Journal of Sichuan University (Medical Sciences), 2020, 51(3): 292-297. DOI: 10.12182/20200360108
Citation: LIU Hong-die, LI Yuan-mei, WANG Wen, et al. Diagnosis and Treatment of Primary Aldosteronism in West China Hospital of Sichuan University from 2009 to 2018[J]. Journal of Sichuan University (Medical Sciences), 2020, 51(3): 292-297. DOI: 10.12182/20200360108

四川大学华西医院2009−2018年原发性醛固酮增多症临床诊断治疗分析

Diagnosis and Treatment of Primary Aldosteronism in West China Hospital of Sichuan University from 2009 to 2018

  • 摘要:
      目的  通过对2009−2018年四川大学华西医院所有原发性醛固酮增多症(primary aldosteronism, PA)住院病例的分析,了解本区域内10年来PA诊治的发展变化趋势。
      方法  所有研究对象均来自四川大学华西医院住院患者,实际时间跨度为2009年1月1日至2018年12月31日。以ICD-10(GBT 14396-2016国家标准)诊断为依据,筛选出诊断中包含“原发性醛固酮增多症”的所有住院病例作为研究对象,分析10年来PA患者基本特征、历年诊断例次、入出院情况、诊治科室、就诊主诉及变化、诊断及治疗方式等。
      结果  共853例患者1 248例诊断例次纳入分析。2009−2018年以来PA诊断例次逐年显著增加,大部分患者(74.33%)经由内分泌代谢科进行诊断。患者中女性多于男性,比例约为1.34∶1。高血压是最重要的入院主诉,而乏力和(或)麻木等低血钾症状作为主诉的占比逐年减少,肾上腺意外瘤作为主诉逐渐增多。通过卧位盐水负荷试验、卡托普利试验和肾上腺静脉采血进行确诊和分型诊断的患者数逐年增加,2016年后大幅增长。单纯手术治疗所占比例逐年下降,更多患者采用了内科治疗方式或经内科确诊后转入外科进行联合治疗。
      结论  2009−2018年,四川大学华西医院对PA的重视加强、诊治流程不断规范以及多学科联合诊治团队的建立均使得PA的诊断率提高。高血压是PA患者最重要的临床表现,应加强在高血压人群中PA的筛查。此外,肾上腺意外瘤成为PA首发表现呈增多趋势,需要引起重视。

     

    Abstract:
      Objective  To summary the clinical diagnosis and treatment of primary aldosteronism (PA) in West China Hospital (WCH) of Sichuan University during 2009-2018.
      Methods  This study enrolled the patients diagnosed as PA and admitted in WCH of Sichuan University from January 2009 to December 2018. The information of the patients including epidemiological and clinical data, diagnosis and treatment as well as therapeutic outcomes were collected and analyzed.
      Results  A total of 853 patients with 1 248 diagnostic cases were included in the analysis, and the diagnosis cases of PA increased year by year from 2009 to 2018. Most patients (74.33%) were confirmed the diagnosis in the Department of Endocrinology and Metabolism and then admitted to the hospital. PA was more frequent in female than in male, with a ratio of female to male about 1.34∶1. Hypertension was the most common chief complaint, in contrast, the proportion of fatigue and/or numbness as the symptoms of hypokalemia was declining. More and more patients were diagnosed because of imaging examination founding adrenal incidentoma. After 2016, more and more patients were diagnosed by recumbent saline suppression test and captopril challenge test, and the number of adrenal venous sampling to classify PA subtypes was increasing to help choosing different treatment options. The proportion of surgical treatment decreased year by year, and more and more patients adopted medical treatment or transferred to surgery with combined treatment instead of simple operation.
      Conclusion  During the past 10 years, remarkable progress was made in the diagnosis and treatment of PA. Hypertension was the most important clinical manifestation of PA, so the screening of PA in hypertensive patients should be strengthened. Adrenal incidentaloma has become prevalent manifestation of PA with an increasing trend, which needs more attention in clinical practice.

     

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