原发性醛固酮增多症术后长期结局分析

Long-term outcome analysis of adrenalectomy for patients with primary hyperaldosteronism

摘要:

目的  探讨原发性醛固酮增多症（PHA）患者肾上腺切除术后长期结局。方法  纳入2001～2011年间所有接受肾上腺切除术的PHA患者。随访记录患者术前术后临床参数和激素水平，并运用SPSS19.0软件进行单因素和多因素分析。结果  共有30名女性患者和24名男性患者接受了腹腔镜下肾上腺切除术。20例患者（37%）术后不再需要降压药物治疗，20名患者（37%）术后高血压得到了改善，14名患者（26%）术后仍然没有改善。因此，高血压得到解决或改善的患者占40/54（74%）。随访平均时间是（49±12）个月，随访结束时，高血压问题得到解决的患者占27/46（58%）。7例患者术后12个月以上时间高血压问题才得到解决。30%患者合并肾上腺增生，但不影响患者临床治疗效果。结论  58%的PHA患者接受腹腔镜下肾上腺切除术后，高血压问题得到解决，但该过程可能需要超过12个月时间。切除后肾上腺增生与高血压持续存在无相关性。

Abstract:

Objective To investigate the long-term outcome of adrenalectomy for patients with primary hyperaldosteronism (PHA). Methods All patients with PHA and adrenalectomy from 2001 to 2011 were identified. Charts and follow-up data were reviewed for clinical parameters and hormone levels. Univariate and multivariate analyses were performed with SPSS 19.0. Results A cohort of 30 female and 24 male patients underwent laparoscopic adrenalectomy. Twenty patients (37%) were cured without any further need of antihypertensive medication, 20 (37%) patients experienced an improvement in hypertension, and 14 (26%) patients remained unaffected. Consequently, hypertension was resolved or improved in 40/54 (74%) patients. At final follow-up after a mean of (49 ± 12) months, resolution of hypertension was observed in 27/46 (58%) patients. Interestingly, in 7 patients a period longer than 12 months was required before a resolution of hypertension was observed. Coexistent adrenal hyperplasia, which was observed in 30% of the patients, did not correlate with the outcome. Conclusions In 58% of patients with PHA, hypertension is resolved after laparoscopic adrenalectomy, but the process may require more than 12 months. Coexistent hyperplasia in the resected adrenal gland is not associated with persistent hypertension.