Department of Medical and Surgical Sciences, University of Padova, Padua, Italy.
Am J Hypertens. 2010 Jan;23(1):2-5. doi: 10.1038/ajh.2009.206. Epub 2009 Nov 12.
An impairment of glucose metabolism, contributing to the increased cardiovascular risk, has been shown in primary aldosteronism (PA). Insulin resistance is associated with nonalcoholic fatty liver disease (NAFLD) and may play a role in its pathophysiology. The aim of this study was to investigate the association between NAFLD and PA, and to identify determinants of NAFLD in this condition.
A total of 40 patients with PA, 40 sex-, age-, and body mass index matched patients with low-renin essential hypertension (LREH) and 40 normotensive subjects were studied. According to ultrasound detection of fatty liver, each group was subdivided in two subsets: with NAFLD and without NAFLD. Patients with diabetes, obesity, and hyperlipidemia were excluded.
Prevalence of NAFLD in PA was similar to that observed in LREH patients, and higher (P < 0.01) than in normotensive controls. Serum potassium was lower in PA than in LREH patients with NAFLD (P < 0.001), while it was similar in PA and LREH patients without NAFLD. At univariate analysis, plasma aldosterone, homeostasis model assessment (HOMA) index and hypokalemia were determinants of NAFLD in PA (P < 0.05), while HOMA index was associated with NAFLD in LREH (P < 0.05). At multivariable analysis, only hypokalemia remained associated with NAFLD in PA (P = 0.02).
The results of this pilot study suggest that, in the absence of major risk factors for liver disease, NAFLD is a frequent finding in PA. Patients with PA and hypokalemia are more insulin resistant and have higher prevalence of NAFLD than those with normokalemia, indicating greater risk for metabolic and liver disease in this subgroup.
原发性醛固酮增多症（PA）患者的葡萄糖代谢受损，导致心血管风险增加。胰岛素抵抗与非酒精性脂肪性肝病（NAFLD）相关，可能在其病理生理学中发挥作用。本研究旨在探讨 NAFLD 与 PA 之间的关系，并确定该疾病中 NAFLD 的决定因素。
共纳入 40 例 PA 患者、40 例性别、年龄和体重指数匹配的低肾素原发性高血压（LREH）患者和 40 例血压正常的受试者。根据超声检测脂肪肝，每个组分为两个亚组：有 NAFLD 和无 NAFLD。排除糖尿病、肥胖和高脂血症患者。
PA 患者的 NAFLD 患病率与 LREH 患者相似，高于血压正常对照组（P<0.01）。PA 患者的血清钾水平低于 LREH 患者（P<0.001），而在 PA 和 LREH 患者中，有或无 NAFLD 者的血清钾水平相似。单因素分析显示，血浆醛固酮、稳态模型评估（HOMA）指数和低血钾是 PA 患者发生 NAFLD 的决定因素（P<0.05），而 HOMA 指数与 LREH 患者的 NAFLD 相关（P<0.05）。多因素分析显示，仅低血钾与 PA 患者的 NAFLD 相关（P=0.02）。
本初步研究结果表明，在无肝脏疾病的主要危险因素的情况下，NAFLD 在 PA 中较为常见。与血钾正常的患者相比，PA 患者伴低血钾时胰岛素抵抗更明显，NAFLD 发生率更高，表明该亚组的代谢和肝脏疾病风险更高。
