醛固酮瘤患者肾上腺切除术后高钾血症的临床危险因素
Clinical risk factors of postoperative hyperkalemia after adrenalectomy in patients with aldosterone-producing adenoma.
作者信息
Park Kyeong Seon, Kim Jung Hee, Ku Eu Jeong, Hong A Ram, Moon Min Kyong, Choi Sung Hee, Shin Chan Soo, Kim Sang Wan, Kim Seong Yeon
机构信息
Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea.
Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea Department of Internal MedicineSeoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, KoreaDepartment of Internal MedicineSeoul Metropolitan Government Borame Medical Center, Seoul 156-707, South KoreaDepartment of Internal MedicineSeoul National University Bundang Hospital, Seongnam-city, Gyeonggi-do, South Korea.
出版信息
Eur J Endocrinol. 2015 Jun;172(6):725-31. doi: 10.1530/EJE-15-0074. Epub 2015 Mar 12.
OBJECTIVE
Unilateral adrenalectomy is the first-line treatment for aldosterone-producing adenomas (APA). Hyperkalemia after adrenalectomy because of contralateral zona glomerulosa insufficiency has been reported. We investigated clinical risk factors to predict postoperative hyperkalemia in patients with APA undergoing adrenalectomy.
DESIGN AND METHODS
This study was conducted by retrospectively reviewing medical records from 2000 to 2012 at Seoul National University Hospital and two other tertiary centers. Data from 124 patients who underwent adrenalectomy were included. Hyperkalemia was defined as serum potassium >5.5 mmol/l. Clinical preoperative risk factors included age, blood pressure, plasma renin activity (PRA), plasma aldosterone concentration (PAC), serum potassium, serum creatinine, glomerular filtration rate (GFR), the mass size on pathology, and mineralocorticoid receptor (MR) antagonist use.
RESULTS
Out of 124 patients, 13 (10.5%) developed postoperative hyperkalemia. The incidences of transient and persistent hyperkalemia were 3.2 and 7.3% respectively. Preoperative PRA and PAC were not significantly different in postoperative hyperkalemic patients compared with normokalemic patients. Patients with persistent hyperkalemia were older, had a longer duration of hypertension, larger mass size on pathology, and lower GFR (all P<0.05). The incidence of postoperative hyperkalemia was not different between MR antagonist users and non-users.
CONCLUSION
Older age (≥53 years), longer duration of hypertension (≥9.5 years), larger mass size on pathology (≥1.95 cm), and impaired preoperative renal function (GFR <58.2 ml/min) were associated with prolonged postoperative hyperkalemia in patients with APA. MR antagonist use did not prevent postoperative hyperkalemia.
目的
单侧肾上腺切除术是原发性醛固酮增多症腺瘤（APA）的一线治疗方法。有报道称，肾上腺切除术后因对侧球状带功能不全可导致高钾血症。我们对接受肾上腺切除术的APA患者术后发生高钾血症的临床危险因素进行了研究。
设计与方法
本研究通过回顾首尔国立大学医院及其他两家三级医疗中心2000年至2012年的病历进行。纳入了124例行肾上腺切除术患者的数据。高钾血症定义为血清钾>5.5 mmol/L。术前临床危险因素包括年龄、血压、血浆肾素活性（PRA）、血浆醛固酮浓度（PAC）、血清钾、血清肌酐、肾小球滤过率（GFR）、病理检查的肿块大小以及是否使用盐皮质激素受体（MR）拮抗剂。
结果
124例患者中，13例（10.5%）术后发生高钾血症。短暂性和持续性高钾血症的发生率分别为3.2%和7.3%。与血钾正常的患者相比，术后高钾血症患者术前的PRA和PAC无显著差异。持续性高钾血症患者年龄较大、高血压病程较长、病理检查肿块较大且GFR较低（均P<0.05）。使用MR拮抗剂与未使用者术后高钾血症的发生率无差异。
结论
年龄较大（≥53岁）、高血压病程较长（≥9.5年）、病理检查肿块较大（≥1.95 cm）以及术前肾功能受损（GFR<58.2 ml/min）与APA患者术后高钾血症持续时间延长有关。使用MR拮抗剂并不能预防术后高钾血症。
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