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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

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

    摘要
  • 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。

     

    Abstract:
      Objective  To investigate the clinical characteristics of aldosterone producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) complicated with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of OSAHS on renin-angiotensin-aldosterone system (RAAS) in APA and IHA patients.
      Methods  The clinical data of 127 patients with primary aldosteronism (PA) diagnosed from May 2010 to Aug. 2019 were retrospectively analyzed. There were 70 cases of APA, 53 cases of IHA. Another 4 cases were primary adrenal hyperplasia (PAH), so not included into further analysis. According to the results of polysomnography, the 123 patients of APA or IHA were divided into OSAHS group (96 cases) and non-OSAHS group (27 cases ). The patients with OSAHS were divided into mild, moderate and severe subgroups based on apnea hypopnea index (AHI).The clinical characteristics, biochemical parameters, plasma renin activity, aldosterone levels, and the ratio of aldosterone to renin activity (ARR) in the patients of APA and IHA complicated with OSAHS were compared with those of the patients without OSAHS.
      Results  There were 49 OSAHS cases (49/70, 70.0%) in APA patients. and 47 OSAHS cases (47/53, 88.7%) in IHA patients. The age, male ratio, body mass index (BMI), waist circumference, triglyceride, blood uric acid, and blood creatinine in APA patients with OSAHS were higher than those in APA patients without OSAHS (P<0.05), while high-density lipoprotein and estimated glomerular filtration rate (eGFR) were lower (P<0.05). Compared to the patients without OSAHS, IHA-OSAHS patients had higher BMI and waist circumference (P<0.05). Moderate/severe OSAHS-APA patients exhibited higher plasma renin activity levels and lower ARR values than the APA patients with no/mild OSAHS (P<0.05). There were no significant differences in plasma renin activity, aldosterone levels, and ARR values between moderate/severe OSAHS-IHA group and no/mild OSAHS-IHA group.
      Conclusion  The prevalence of OSAHS is significantly higher in the patients with PA than normal population, and OSAHS may aggravate glycose, lipid and uric acid metabolism in PA patients. Moderate/severe OSAHS can increase renin levels and decrease ARR values in APA patients, but has no significant effect on RAAS in IHA patients.

     

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