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醛固酮瘤及特发性醛固酮增多症合并阻塞性睡眠呼吸暂停低通气综合征的临床特征分析

左飞杰 周小花 任艳 陈涛 田浩明

左飞杰, 周小花, 任艳, 等. 醛固酮瘤及特发性醛固酮增多症合并阻塞性睡眠呼吸暂停低通气综合征的临床特征分析[J]. 四川大学学报(医学版), 2020, 51(3): 298-303. doi: 10.12182/20200560602
引用本文: 左飞杰, 周小花, 任艳, 等. 醛固酮瘤及特发性醛固酮增多症合并阻塞性睡眠呼吸暂停低通气综合征的临床特征分析[J]. 四川大学学报(医学版), 2020, 51(3): 298-303. doi: 10.12182/20200560602
ZUO Fei-jie, ZHOU Xiao-hua, REN Yan, et al. Clinical Characteristics of Aldosterone Producing Adenoma and Idiopathic Hyperaldosteronism with Obstructive Sleep Apnea Hypopnea Syndrome[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2020, 51(3): 298-303. doi: 10.12182/20200560602
Citation: ZUO Fei-jie, ZHOU Xiao-hua, REN Yan, et al. Clinical Characteristics of Aldosterone Producing Adenoma and Idiopathic Hyperaldosteronism with Obstructive Sleep Apnea Hypopnea Syndrome[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2020, 51(3): 298-303. doi: 10.12182/20200560602

栏目: 原发性醛固酮增多症诊断进展

醛固酮瘤及特发性醛固酮增多症合并阻塞性睡眠呼吸暂停低通气综合征的临床特征分析

doi: 10.12182/20200560602
基金项目: 四川省科技计划项目-应用基础项目(No.2019YJ0040)、四川大学华西医院学科卓越发展1.3.5工程项目(人才卓越发展项目)(No.ZYGD18022)和四川大学华西医院临床研究孵化项目(No.2018HXFH009)资助
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    E-mail:dr.chentao@qq.com

Clinical Characteristics of Aldosterone Producing Adenoma and Idiopathic Hyperaldosteronism with Obstructive Sleep Apnea Hypopnea Syndrome

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  • 摘要:   目的  探讨原发性醛固酮增多症(PA)中醛固酮瘤(APA)和特发性醛固酮增多症(IHA)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床特征及OSAHS对APA及IHA患者肾素-血管紧张素-醛固酮系统(RAAS)的影响。  方法  回顾性分析2010年5月至2019年8月在四川大学华西医院确诊为PA患者(127例)的临床资料,其中APA(70例)及IHA(53例)患者根据多导睡眠监测结果,将其分为合并OSAHS(APA-、IHA-OSAHS患者共96例)组和未合并OSAHS(APA-、IHA-nonOSAHS患者共27例)组。OSAHS根据睡眠呼吸暂停低通气指数(AHI)分为轻、中、重度亚组。对APA、IHA合并与未合并OSAHS组患者的临床特征、生化指标及血浆肾素活性、醛固酮水平、醛固酮与肾素活性比值(ARR)进行比较。  结果  ① 127例PA患者中APA患者占55.1%(70例),IHA患者占41.7%(53例),原发性肾上腺皮质增生(PAH)患者占3.2%(4例)。PA-OSAHS患者99例,占78.0%,其中APA-OSAHS患者49例,占APA患者的70.0%(49/70),IHA-OSAHS患者47例,占IHA患者的88.7%(47/53)。②APA-OSAHS组年龄、男性构成比、体质量指数(BMI)、腰围、三酰甘油、血尿酸、血肌酐均高于APA-nonOSAHS组(P<0.05),高密度脂蛋白、估算肾小球滤过率(eGFR)低于APA-nonOSAHS组(P<0.05);IHA-OSAHS组BMI和腰围高于IHA-nonOSAHS组(P<0.05)。③中重度OSAHS-APA患者与轻度或无OSAHS-APA患者比较,血浆肾素活性水平升高,ARR值降低(P<0.05);中重度OSAHS-IHA组与轻度或无OSAHS-IHA组比较,血浆肾素活性、醛固酮水平及ARR值差异均无统计学意义。  结论  在PA患者中,OSAHS患病率高于正常人群,且OSAHS会加重PA患者的糖脂及尿酸代谢异常。中重度OSAHS可使APA患者肾素水平升高、ARR值降低,但对IHA患者RAAS系统影响不显著。
  • 表  1  APA-OSAHS与APA-nonOSAHS患者的临床特征

    Table  1.   Clinical characteristics of the APA with OSAHS and APA without OSAHS patients

    CharacteristicAPA-OSAHS group (n=49)APA-nonOSAHS group (n=21)P
    Age/yr.49.1±9.939.4±12.00.001
    Male/case (%)30 (61.2)5 (23.8)0.004
    BMI/(kg/m2)26.4±4.122.9±3.30.001
    WC/cm92.7±9.780.3±8.00.000
    Potassium/(mmol/L)3.0±0.53.0±0.50.747
    24 h urinary K+*/(mmol/L)46.3 (29.4, 57.4)54.5 (42.4, 86.0)0.048
    SBP/mmHg176±22183±230.256
    DBP/mmHg109±15112±110.451
    Fasting glucose*/(mmol/L)4.9 (4.6, 5.3)4.6 (4.3, 5.2)0.137
    HbA1C*/%5.6 (5.3, 5.8)5.5 (5.0, 5.7)0.221
    Triglycerides*/(mmol/L)1.4 (0.9, 2.1)0.9 (0.6, 1.0)0.000
    Total cholesterol/(mmol/L)4.4±0.84.4±0.90.744
    HDL cholesterol/(mmol/L)1.2±0.41.5±0.40.002
    LDL cholesterol/(mmol/L)2.6±0.72.4±0.80.263
    Uric acid/(µmol/L)337.1±96.1273.8±71.10.009
    Plasma creatinine/(µmol/L)74.0±20.858.9±14.20.003
    eGFR/(mL/(mL·1.73 m2) )96.9±18.5111.0±16.80.008
      *Median (P25, P75); APA: Aldosterone producing adenoma; OSAHS: Obstructive sleep apnea hypopnea syndrome; BMI: Body mass index; WC: Waist circumference; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; 1 mmHg=0.133 kPa; HbA1C: Glycated hemoglobin A1C; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; eGFR: Estimated glomerular filtration rate
    下载: 导出CSV

    表  2  IHA-OSAHS与IHA-nonOSAHS患者的临床特征

    Table  2.   Clinical characteristics of the IHA with OSAHS and IHA without OSAHS patients

    CharacteristicIHA-OSAHS group (n=47)IHA-nonOSAHS group (n=6)P
    Age/yr.51.7±10.651.2±10.30.900
    Male/case (%)26 (55.3)3 (50.0)0.805
    BMI/(kg/m2)26.6±3.722.6±3.30.014
    WC/cm93.9±10.179.2±9.30.004
    Potassium/(mmol/L)3.3±0.43.1±0.50.321
    24 h urinary K+/(mmol/L)46.8±15.931.9±12.10.052
    SBP/mmHg170±23175±250.600
    DBP/mmHg105±15108±150.676
    Fasting glucose*/(mmol/L)5.1 (4.7, 5.8)4.7 (4.4, 5.6)0.197
    HbA1C*/%6.0 (5.3, 6.5)6.0 (5.3, 6.4)0.891
    Triglycerides*/(mmol/L)1.6 (1.2, 2.0)1.4 (0.8, 2.1)0.246
    Total cholesterol/(mmol/L)4.5±1.14.5±0.60.923
    HDL cholesterol/(mmol/L)1.2±0.31.3±0.10.437
    LDL cholesterol/(mmol/L)2.7±0.92.6±0.60.734
    Uric acid/(µmol/L)373.7±85.0348.3±96.80.501
    Plasma creatinine/(µmol/L)71.0±18.478.5±28.30.378
    eGFR/(mL/(mL·1.73 m2) )98.9±19.096.4±24.20.787
    IHA:Idiopathic hyperaldosteronism; *, OSAHS, BMI, WC, SBP, DBP, HbA1C, HDL, LDL and eGFR note the same as table 1
    下载: 导出CSV

    表  3  中重度OSAHS-APA组与轻度或无OSAHS-APA组RAAS的比较

    Table  3.   Comparison of renin-angiotensin-aldosterone system (RAAS) between the moderate/severe OSAHS with APA group and no/mild OSAHS with APA group

    ItemNo/mild OSAHS-APA group (n=40)Moderate/severe OSAHS-APA group (n=30)P
    Supine PRA/(ng/mL·h)0.09 (0.05, 0.14)0.14 (0.06, 0.41)0.021
    Supine PAC/(ng/dL)25.6 (21.4, 36.8)26.2 (23.8, 33.1)0.809
    Supine ARR/((ng/dL):(ng/mL·h))355.3 (178.9, 512.2)184.1 (72.1, 448.9)0.039
    Upright PRA/(ng/mL·h)0.13 (0.06, 0.44)0.40 (0.12, 0.88)0.032
    Upright PAC/(ng/dL)32.4 (24.1, 40.0)29.1 (22.7, 35.0)0.352
    Upright ARR/((ng/dL):(ng/mL·h))290.8 (143.1, 541.4)93.2 (34.1, 275.8)0.021
     Values are indicated as median (P25, P75); PRA: Plasma renin activity; PAC: Plasma aldosterone concentration; ARR: Aldosterone to renin activity ratio; 1 ng/dL=27.7 pmol/L
    下载: 导出CSV

    表  4  中重度OSAHS-IHA组与无或轻度OSAHS-IHA组RAAS的比较

    Table  4.   Comparison of renin-angiotensin-aldosterone system (RAAS) between the moderate/severe OSAHS with IHA group and no/mild OSAHS with IHA group

    ItemNo/mild OSAHS-IHA group (n=20)Moderate/severe OSAHS-IHA group (n=33)P
    Supine PRA/(ng/mL·h)0.16 (0.08, 0.27)0.16 (0.07, 0.25)0.559
    Supine PAC/(ng/dL)18.5 (14.6, 22.1)22.4 (17.8, 24.1)0.072
    Supine ARR/((ng/dL):(ng/mL·h))116.8 (74.4, 254.3)182.6 (97.4, 295.3)0.178
    Upright PRA/(ng/mL·h)0.29 (0.24, 0.59)0.29 (0.12, 0.51)0.493
    Upright PAC/(ng/dL)23.0 (19.9, 29.7)25.5 (22.9, 34.7)0.243
    Upright ARR/((ng/dL):(ng/mL·h))72.7 (48.8, 111.9)87.0 (56.7, 234.8)0.183
    Values are indicated as median (P25,P75); OSAHS notes the same as table 1; IHA notes the same as table 2; PRA, PAC, ARR note the same as table 3
    下载: 导出CSV
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出版历程
  • 收稿日期:  2019-11-19
  • 修回日期:  2020-01-16
  • 刊出日期:  2020-05-01

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