原发性醛固酮增多症患者肾小球高滤过与左心室结构和功能的关系
The Association between Glomerular Hyperfiltration and Left Ventricular Structure and Function in Patients with Primary Aldosteronism.
作者信息
Liao Min-Tsun, Wu Xue-Ming, Chang Chin-Chen, Liao Che-Wei, Chen Ying-Hsien, Lu Ching-Chu, Lin Yen-Ting, Chang Yi-Yao, Hung Chi-Sheng, Lin Lung-Chun, Lai Chao-Lun, Lin Lian-Yu, Wu Vin-Cent, Ho Yi-Lwun, Wu Kwan-Dun, Lin Yen-Hung
机构信息
1. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan;
2. Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan;
出版信息
Int J Med Sci. 2015 May 3;12(5):369-77. doi: 10.7150/ijms.10975. eCollection 2015.
BACKGROUND
Glomerular hyperfiltration has been recently noticed as an important issue in primary aldosteronism (PA) patients. However, its effect on the cardiovascular system remains unknown.
METHODS
We prospectively analyzed 47 PA patients including 11 PA patients with estimated glomerular filtration rate (eGFR) > 130 ml/min per 1.73 m2 (group 1), and 36 PA patients with eGFR 90-110 ml/min per 1.73 m2 (group 2). Fourteen essential hypertension (EH) patients with eGFR 90-110 ml/min per 1.73 m2 were included as the control group (group 3). Echocardiography including left ventricular mass index (LVMI) measurement and tissue Doppler imaging (TDI) was performed. Predicted left ventricular mass (LVM) was calculated. Inappropriate LVM was defined as an excess of > 35% from the predicted value.
RESULTS
The value of LVMI decreased significantly in order from groups 1 to 3 (group 1>2>3). While group 2 had a significantly higher percentage of inappropriate LVM than group 3, the percentage of inappropriate LVM were comparable in groups 1 and 2. Group 1 had a higher mitral E velocity, E/A ratio than that of group 2. In the TDI study, the E/E' ratio also decreased significantly in order from groups 1 to 3 (group 1>2>3). Group 2 had lower E' than that of group 3, although the E' of group 1 and 2 were comparable.
CONCLUSIONS
Although PA patients with glomerular hyperfiltration were associated with higher LVMI, higher mitral E velocity, higher E/E' ratio, they had comparable E' with PA patients with normal GFR. This phenomenon may be explained by higher intravascular volume in this patient group.
背景
肾小球高滤过最近被视为原发性醛固酮增多症（PA）患者的一个重要问题。然而，其对心血管系统的影响仍不清楚。
方法
我们前瞻性分析了47例PA患者，其中11例估计肾小球滤过率（eGFR）>130 ml/（min·1.73 m²）的PA患者为1组，36例eGFR为90 - 110 ml/（min·1.73 m²）的PA患者为2组。纳入14例eGFR为90 - 110 ml/（min·1.73 m²）的原发性高血压（EH）患者作为对照组（3组）。进行了包括左心室质量指数（LVMI）测量和组织多普勒成像（TDI）的超声心动图检查。计算预测左心室质量（LVM）。不适当的LVM定义为超过预测值>35%。
结果
LVMI值从1组到3组依次显著降低（1组>2组>3组）。虽然2组不适当LVM的百分比显著高于3组，但1组和2组不适当LVM的百分比相当。1组的二尖瓣E峰速度、E/A比值高于2组。在TDI研究中，E/E'比值也从1组到3组依次显著降低（1组>2组>3组）。2组的E'低于3组，尽管1组和2组的E'相当。
结论
虽然肾小球高滤过的PA患者与较高的LVMI、较高的二尖瓣E峰速度、较高的E/E'比值相关，但他们与GFR正常的PA患者的E'相当。这种现象可能是由于该患者组较高的血管内容量所致。
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