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原发性醛固酮增多症或需重新定义！美研究称，患病率远高于想象

2020-06-09 朱朱 中国循环杂志

原发性醛固酮增多症
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一直以来，原发性醛固酮增多症（原醛）被认为是高血压的继发病因之一。过去认为原醛比较少见，但近年来的研究表明，其患病率并不低。

一直以来，原发性醛固酮增多症（原醛）被认为是高血压的继发病因之一。过去认为原醛比较少见，但近年来的研究表明，其患病率并不低。
 
阜外医院蔡军等2018年发表的一项单中心研究显示，在高血压住院患者中，原醛占5.2%。
 
前不久，我国重庆学者在JACC上发表的研究显示，新诊高血压患者中至少有4%存在原醛。
 
5月26日，《内科学年鉴》杂志在线发表的一项美国横断面研究发现，根据口服钠抑制试验结果，以尿醛固酮水平>12 μg/24小时为诊断标准，在血压正常者以及Ⅰ级高血压、Ⅱ级高血压、顽固性高血压患者中，估计原醛的患病率分别高达11.3%、15.7%、21.6%、22.0%。
 
血压越高、尿钾排泄越多、血钾水平越低，肾素非依赖性的醛固酮生成越多。
 
研究者认为，这一研究结果支持对原醛重新进行定义，它并非一种罕见的、明确无误的疾病，可能参与原发性高血压的发病过程，而非高血压的继发病因。
 
他们指出，原醛的患病率很高，而且很大比例未被发现。因此，临床医生应加强对原醛的筛查。
 
当前指南建议，重度高血压患者或高血压合并低钾血症、睡眠呼吸暂停、肾上腺瘤的患者应筛查原醛。
 
在同时发表的一篇题为“原醛：处在转折点”的配套述评中，美国内分泌学会原醛管理指南修订工作组主席John W. Funder指出，该研究是“游戏规则改变者（game changer）”。
 
他表示，该研究中得出的原醛患病率是基于单次血浆醛固酮水平这一传统方法诊断的原醛患病率的3~5倍。这一研究结果适用于整个美国和其他国家。
 
他认为，当前指南中的大部分内容应该修改，要彻底重新制定建议，以指导临床医生进行高血压治疗。
 
原醛常根据血浆醛固酮/肾素活性比值（ARR）进行评估，ARR和血浆醛固酮水平升高为阳性，可通过口服钠负荷试验或静脉生理盐水负荷试验、氢化可的松抑制试验、卡托普利试验确诊。
 
这项最新的美国研究显示，在通过生化指标诊断的原醛患者中，ARR的诊断敏感性和阴性预测价值均较低。
 
研究者表示，这说明，用ARR来筛查和排除原醛存在局限性，可能会导致很多病例漏诊。
 
该研究涉及美国4个教学医疗中心，纳入血压正常者289名以及Ⅰ级高血压、Ⅱ级高血压、顽固性高血压患者分别115例、203例、408例。
 
来源：
[1]刘小宁，蔡军，马文君，等. 原发性醛固酮增多症高血压患者临床特征分析. 中国循环杂志, 2018, 33: 836.
[2]Primary Aldosteronism in Patients in China With Recently Detected Hypertension. J Am Coll Cardiol, 2020, 75(16): 1913-1922.
[3]The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study. Ann Intern Med. 26 May 2020
[4]Primary Aldosteronism: At the Tipping Point. Ann Intern Med. 26 May 2020

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    2020-08-12 FukaiBao

    #醛固酮增多症#

    0

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    2020-12-07 hukaixun

    #新定义#

    0

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    2020-10-07 jiyangfei

    #原发性#

    0

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    2020-06-11 xinmeili

    #患病率#

    0

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    2020-06-11 cmsvly

    #醛固酮#

    0

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