摘要
目的 通过分析原发性醛固酮增多症(primary aldosteronism,PA)患者蛋白尿相关影响因素,探讨PA引起肾脏损害的致病因子及可能机制。方法 入选2013年1月至2019年12月瑞金医院北部院区高血压专科住院、并经初筛为PA疑似患者。通过盐水负荷试验将初筛患者分为PA组(盐后醛固酮>100 pg/ml)及原发性高血压(essential hypertension,EHT)组(盐后醛固酮<60 pg/ml)。采集一般资料、血生化、相关激素及24 h尿蛋白等。以24 h尿蛋白定量>150 mg定义为蛋白尿。结果 共入选374例患者,其中PA组142例,占比37.98%。PA组尿蛋白定量及蛋白尿检出率均高于EHT组(P<0.05)。采用logistic回归分析并校正相关危险因素,与EHT组相比,PA组蛋白尿风险增加2.23倍(P=0.016)。进一步在PA患者中行多元线性回归分析尿蛋白影响因素,盐后醛固酮(自主分泌醛固酮)每增加1 pg/dl,尿蛋白增加1.32 mg/24 h。自主分泌的醛固酮、血糖、病程及男性是尿蛋白的危险因素。结论 PA患者较EHT患者蛋白尿发生率高。肾上腺自主分泌的醛固酮、血糖、病程及男性是PA患者尿蛋白的影响因素,特别是肾上腺自主分泌的醛固酮,可能是PA引起肾脏损害的可变的、特异性致病因子。
Objective To analyze the related factors of proteinuria in patients with primary aldosteronism(PA),and to explore the pathogenic factors and possible mechanism of renal damage caused by PA.Methods Patients hospitalized in the department of hypertension,Northern Area of Ruijin Hospital and screened as suspected PA were selected from January 2013 to December 2019.The patients were divided into PA group(post salt aldosterone>100 pg/ml) and essential hypertension(EHT) group(post salt aldosterone<60 pg/ml).The baseline characteristic,blood biochemistry,related hormones and 24-hour urinary protein were collected.Proteinuria was defined as 24-hour urinary protein quantity>150 mg.Results A total of 374 patients were selected,including 142 patients in PA group,accounting for 37.98%.The detection rates of proteinuria and the urine protein quantity in PA group were higher than those in EHT group(P<0.05).Logistic regression analysis was used to correct the relevant risk factors.The risk of proteinuria in PA group was 2.23 times higher than that in EHT group(P=0.016).Furthermore,multiple linear regression was used to analyze the influencing factors of urinary proteinin PA patients.For every 1 pg/dl increase of autonomic aldosterone secretion,urinary proteinin increased by 1.32 mg/24 hours.Autonomously secreted aldosterone,blood glucose,course of disease and male are the risk factors of urinary protein.Conclusion The incidence of proteinuria was higher in PA patients than in EHT patients.Autonomously secreted aldosterone,blood glucose,course of disease and male are the influencing factors of proteinuria in PA patients,especially autonomously secreted aldosterone may be a variable and specific pathogenic factor of renal damage caused by PA.
作者
常桂丽
刘常远
李明春
胡哲
陈静
操群安
陈歆
初少莉
CHANG Guili;LIU Changyuan;LI Mingchun;HU Zhe;CHEN Jing;CAO Qunan;CHEN Xin;CHU Shaoli(Department of Hypertension,Rujin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201821,China)
出处
《世界临床药物》
CAS
2022年第7期885-890,共6页
World Clinical Drug
