| 摘要: |
| ［摘要］ 目的 探讨螺内酯治疗原发性醛固酮增多症(PA)的效果，分析影响其临床缓解的因素。方法 回顾性分析2015-01～2018-12该院收治95例PA患者的临床资料，所有患者接受螺内酯治疗。分析治疗后患者的血压、血钾改善情况，以及一般临床指标的变化情况。根据治疗效果将PA患者分为缓解组（39例）和未缓解组（56例），比较两组治疗前的一般资料及生化指标检查结果，分析患者在接受螺内酯治疗后获得临床缓解的影响因素。结果 治疗后，患者的临床缓解率为41.05%（39/95），血压达标率为49.47%（47/95），血钾达标率为72.63%（69/95）。治疗后患者的收缩压、舒张压和醛固酮肾素比值（ARR）水平较治疗前降低，腹围、血钾、坐位肾素和坐位醛固酮水平较治疗前升高，差异有统计学意义（P<0.05）。未缓解组中男性、低血钾患者、坐位血浆醛固酮≥20 ng/dL的人数比例以及坐位醛固酮水平均显著高于缓解组（P<0.05）。Logistic回归分析结果显示，在治疗前合并低血钾以及血浆醛固酮≥20 ng/dL是螺内酯治疗PA效果欠佳的影响因素（P<0.05）。结论 PA患者治疗前合并低血钾及血浆醛固酮水平≥20 ng/dL是导致螺内酯治疗效果欠佳的影响因素，临床医师需要加强这部分患者的随访及干预。 |
| 关键词: 原发性醛固酮增多症 螺内酯 药物治疗 临床疗效 |
| DOI：10.3969/j.issn.1674-3806.2020.06.08 |
| 分类号:R 586.24 |
| 基金项目:中国医学科学院中央级公益性科研院所基本科研项目（编号：2019PT330003） |
|
| Evaluation of the therapeutic effect of spironolactone on primary aldosteronism and analysis of the factors affecting clinical remission |
|
WANG Xiao-tong, LUO Qin, LI Nan-fang
|
|
Medical College of Shihezi University, Xinjiang Uygur Autonomous Region 832000, China
|
| Abstract: |
| ［Abstract］ Objective To explore the effect of spironolactone on treatment of primary aldosteronism(PA), and to analyze the factors affecting clinical remission. Methods The clinical data of 95 PA patients in our hospital from January 2015 to December 2018 were retrospectively analyzed. All the patients were treated with spironolactone. The improvements of blood pressure and blood potassium, and the changes of general clinical indexes were analyzed. The PA patients were divided into remission group(39 cases) and non-remission group(56 cases) according to different therapeutic effects. The general data and the results of biochemical index examination were compared between the two groups before treatment, and the factors affecting the clinical remission of the patients receiving spironolactone were analyzed after treatment. Results After treatment, the clinical remission rate was 41.05%(39/95); the control rate of blood pressure was 49.47%(47/95) and the control rate of blood potassium was 72.63%(69/95). Compared with those before treatment, the levels of systolic pressure, diastolic pressure, and aldosterone to renin ratio(ARR) were lower, while the levels of abdominal circumference, blood potassium, seated renin, and seated aldosterone were higher, and the differences were statistically significant(P<0.05). The proportion of males, the proportion of the patients with hypokalemia, the proportion of the patients with seated plasma aldosterone ≥20 ng/dL, and the seated aldosterone level in the non-remission group were significantly higher than those in the remission group(P<0.05). The results of Logistic regression analysis showed that the combination of hypokalemia and plasma aldosterone ≥20 ng/dL before treatment was the influencing factor of the poor effect of spironolactone on PA(P<0.05). Conclusion Hypokalemia and plasma aldosterone level ≥20 ng/dL in PA patients before treatment are the influencing factors leading to the poor therapeutic effect of spironolactone on PA, and clinicians need to strengthen the follow-up and intervention of these patients. |
| Key words: Primary aldosteronism(PA) Spironolactone Drug therapy Clinical efficacy |
