Abstract:【Objective】To explore the related factors of abnormal glucose metabolism in patients with primary aldosteronism (PA). 【Methods】The clinical data of 195 patients with PA first diagnosed in the Department of Cardiology of our hospital from January 2015 to December 2019 (observation group) were analyzed retrospectively, and 195 patients with essential hypertension were included as the control group. The blood glucose metabolism indexes, blood lipid level, consulting room blood pressure and ambulatory blood pressure of the two groups were compared. The effects of renin, aldosterone and aldosterone/renin activity ratio (ARR) on blood glucose metabolism indexes were analyzed by multiple linear regression. 【Objective】The course of hypertension, body mass index (BMI), the proportion of abnormal glucose metabolism, fasting blood glucose (FPG), glycosylated hemoglobin (HbAc1), K, aldosterone and ARR in the observation group were higher than those in the control group, and the renin level and the proportion of women in the observation group were lower than those in the control group (P<0.05). The consulting room blood pressure, 24-hour blood pressure, daytime and nighttime blood pressure in the observation group were higher than those in the control group, and the decrease rate of nighttime systolic blood pressure was lower than that in the control group (P<0.05). The proportion of FPG and abnormal glucose metabolism and diabetes in patients with PA adrenal hyperplasia were higher than those in adrenal adenomas (P<0.05). Multiple linear regression analysis showed that FPG and HbAc1 levels were independently correlated with aldosterone levels (P<0.05). 【Conclusion】The blood glucose level in PA patients is higher than that in pH patients. The aldosterone level is independently related to the increase of FPG and HbAc1.
[1] 中华医学会内分泌学分会肾上腺学组.原发性醛固酮增多症诊断治疗的的专家共识[J].中华内分泌代谢杂志,2016,32(3):188-195. [2] DIAZ-OTERO J M. Endothelial mineralocorticoid receptor mediates paren-chymal arteriole and posterior cerebral artery remodeling during angiotensin II-induced hypertension[J].Hypertension,2017,70(6):1113-1121. [3] WU X,YU J,TIAN H. Cardiovascular risk in primary aldosteronism A systematic review and meta-analysis[J].Medicine (Baltimore),2019,98(26):e15985. [4] REMDE H,HANSLIK G,RAYES N,et al.Glucose metabolism in primary aldosteronism[J].Horm Metab Res,2015, 47(13):987-993. [5] TSURUTANI Y,SUGISAWA C,ISHIDA A,et al.Aldosterone excess may inhibit insulin secretion: A comparative study on glucose metabolism pre- and post-adrenalectomy in patients with primary aldosteronism[J].Endocr J,2017,64(3):339-346. [6] 唐超燕.原发性醛固酮增多症与原发性高血压患者糖脂代谢异常及尿酸水平的比较[J].中外医学研究,2017,15(29):42-43. [7] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017版)[J].中华糖尿病杂志,2018,10(1):4-67. [8] CHEN W, LI F, HE C,et al.Elevated prevalence of abnormal glucose metabolism in patients with primary aldosteronism: a meta-analysis[J].Ir J Med Sci,2014,183(2):283-291. [9] 张智华,周玲,骆秦,等.不同性别原发性醛固酮增多症患者代谢综合征患病情况分析及其与年龄、BMI的关系[J].海南医学院学报,2019,25(24):1857-1862. [10] KARDALAS E, PASCHOU SA, ANAGNOSTIS P, et al Hypokalemia: a clinical update[J].Endocr Connect,2018, 7(4):R135-R146. [11] REINCKE M,MEISINGER C,HOLLE R,et al. Is primary aldosteronism associated with diabetes ?Results of the German Corm'S Registry [J].Horm Metab Res,2010,42(6):435-439. [12] HANSLIK G,WALLASCHOFSKI H,DIETZ A,et al. Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn's Registry[J].Eur J Endocrinol,2015,173(5):665-675. [13] SYDNEY G I, IOAKIM K J, PASCHOU S A. Insulin resistance and adrenal incidentalomas: a bidirectional relationship[J].Maturitas,2019,121:1-6. [14] KWAK M K,LEE J Y,KIM B J,et al.Effects of Primary Aldosteronism and Different Therapeutic Modalitieson Glucose Metabolism[J].J Clin Med,2019, 8(12):2194. [15] 郭瑞敏. 原发性醛固酮增多症代谢异常及基因分型研究[D].上海:上海交通大学,2007. [16] 王新国.原发性醛固酮增多症患者糖代谢紊乱情况分[D].乌鲁木齐:新疆医科大学,2012.