单侧肾上腺切除对PHA 患者 肾上腺皮质功能的影响

Effect of unilateral adrenalectomy on adrenocortical function in patients with primary aldosteronism

摘要:

目的 探讨单侧肾上腺切除治疗原发性醛固酮增多症（PHA）对肾上腺皮质分泌功能的影响。 方法 选择2014 年12 月-2017 年08 月在郑州大学第二附属医院泌尿外科行单侧肾上腺切除术的70 例PHA 患者为研究对象，比较手术前后患者肾上腺皮质分泌功能。结果 患者术后14 d 舒张压、收缩压、尿醛固酮、 血醛固酮低于术前（P <0.05）；术后14 d 血钾、促肾上腺皮质激素（ACTH）较术前升高（P <0.05）；术后 14 d 血肌酐、皮质醇较术前无明显变化（P >0.05）；术后14 d 的ACTH 兴奋1 mg 地塞米松抑制试验中，各 时间点皮质醇水平均低于术前（P <0.05）。结论 PHA 患者行单侧肾上腺切除后可降低肾上腺皮质储备功能， 但对肾上腺皮质分泌功能影响较小。

Abstract:

Objective To investigate the effect of unilateral adrenalectomy on adrenocortical function in the patients with primary aldosteronism (PA). Methods Seventy PA patients, who underwent unilateral adrenalectomy in the Department of Urology, the Second Affiliated Hospital of Zhengzhou University from December 2014 to August 2017, were selected as the subjects. The secretion function of adrenal cortex was compared before and after surgery. Results Diastolic blood pressure, systolic blood pressure, urine aldosterone and blood aldosterone on the 14th d after operation were lower than those before operation (P < 0.05). Blood potassium and adrenocorticotropic hormone (ACTH) on the 14th d after operation were higher than those before operation (P < 0.05). Serum creatinine and cortisol on the 14th d after operation had no statistical differences from those before operation (P > 0.05). ACTHstimulated 1 mg Dexamethasone suppression test on the 14th d after operation revealed that cortisol level at each time point was lower than that before operation (P < 0.05). Conclusions Adrenocortical reserve function can be reduced by unilateral adrenalectomy in the patients with primary aldosteronism, but it has little effect on adrenocortical secretory function.