Holaj Robert, Rosa Ján, Zelinka Tomáš, Štrauch Branislav, Petrák Ondřej, Indra Tomáš, Šomlóová Zuzana, Michalský David, Novák Květoslav, Wichterle Dan, Widimský Jiří
a3rd Department of Medicine b1st Department of Surgery cDepartment of Urology, Centre for Hypertension General University Hospital and 1st Faculty of Medicine, Charles University in Prague dDepartment of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
J Hypertens. 2015 Apr;33(4):874-82; discussion 882. doi: 10.1097/HJH.0000000000000464.
Aldosterone has been shown to substantially contribute to the accumulation of different types of collagen fibres and growth factors in the arterial wall, thus increasing wall thickness. A previous study showed reduction of increased common carotid intima-media thickness (IMT) in patients with primary aldosteronism 1 year after adrenalectomy. Our study in patients with primary aldosteronism was aimed at comparing the long-term effect of adrenalectomy vs. spironolactone therapy on common carotid IMT regression.
Forty-two patients with confirmed primary aldosteronism (21 with aldosterone-producing adenoma treated by unilateral laparoscopic adrenalectomy, 21 treated with spironolactone) were investigated by carotid ultrasound at baseline and 1 and 6 years after the specific treatment.
There was a decrease in common carotid IMT from 0.956 ± 0.140 to 0.900 ± 0.127 mm (-5.9%; P < 0.05) at 1 year and to 0.866 ± 0.130 mm (-9.4%; P < 0.01) at 6 years after adrenalectomy; in the spironolactone group, common carotid IMT decreased from 0.917 ± 0.151 to 0.900 ± 0.165 mm (-1.8%; NS) at 1 year and to 0.854 ± 0.176 mm (-6.8%; P < 0.01) at 6 years of treatment. The magnitude of improvement at 1 year was significantly higher (by 70%; P < 0.05) in the adrenalectomy group; however, the difference (by 27%) became nonsignificant at 6 years. Comparing the adrenalectomy and spironolactone groups, there was no significant difference in blood pressure decrease after treatment.
In the long term, spironolactone therapy in patients with primary aldosteronism had significant effect on regression of IMT, which was comparable to surgical treatment in patients with unilateral forms of primary aldosteronism.
醛固酮已被证明在动脉壁中不同类型胶原纤维和生长因子的积累中起重要作用，从而增加动脉壁厚度。先前的一项研究表明，原发性醛固酮增多症患者在肾上腺切除术后1年，颈总动脉内膜中层厚度（IMT）增加的情况有所减轻。我们对原发性醛固酮增多症患者的研究旨在比较肾上腺切除术与螺内酯治疗对颈总动脉IMT消退的长期影响。
42例确诊为原发性醛固酮增多症的患者（21例因醛固酮分泌性腺瘤接受单侧腹腔镜肾上腺切除术，21例接受螺内酯治疗）在基线时以及特定治疗后1年和6年接受颈动脉超声检查。
肾上腺切除术后1年，颈总动脉IMT从0.956±0.140降至0.900±0.127mm（-5.9%；P<0.05），6年后降至0.866±0.130mm（-9.4%；P<0.01）；在螺内酯组中，治疗1年时颈总动脉IMT从0.917±0.151降至0.900±0.165mm（-1.8%；无统计学意义），治疗6年时降至0.854±0.176mm（-6.8%；P<0.01）。肾上腺切除组在1年时的改善幅度明显更高（高70%；P<0.05）；然而，6年时差异（27%）变得无统计学意义。比较肾上腺切除组和螺内酯组，治疗后血压下降无显著差异。
长期来看，原发性醛固酮增多症患者使用螺内酯治疗对IMT消退有显著效果，这与单侧原发性醛固酮增多症患者的手术治疗效果相当。
