常染色体显性多囊肾病患者的醛固酮增多症与心血管风险
Hyperaldosteronism and cardiovascular risk in patients with autosomal dominant polycystic kidney disease.
作者信息
Lai Silvia, Petramala Luigi, Mastroluca Daniela, Petraglia Emanuela, Di Gaeta Alessandro, Indino Elena, Panebianco Valeria, Ciccariello Mauro, Shahabadi Hossein H, Galani Alessandro, Letizia Claudio, D'Angelo Anna Rita
机构信息
Department of Clinical Medicine, Sapienza University of Rome, Rome Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, Rome Cobellis Clinic, Tirreno SRL, Vallo della lucania, Sapri, Salerno Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome Department of Clinical and Experimental Sciences, University of Brescia, Brescia Department of Obstetrical-Gynecological Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy.
出版信息
Medicine (Baltimore). 2016 Jul;95(29):e4175. doi: 10.1097/MD.0000000000004175.
Hypertension is commonly associated with autosomal dominant polycystic kidney disease (ADPKD), often discovered before the onset of renal failure, albeit the pathogenetic mechanisms are not well elucidated. Hyperaldosteronism in ADPKD may contribute to the development of insulin resistance and endothelial dysfunction, and progression of cardiorenal disease. The aim of study was to evaluate the prevalence of primary aldosteronism (PA) in ADPKD patients and identify some surrogate biomarkers of cardiovascular risk.We have enrolled 27 hypertensive ADPKD patients with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min, evaluating the renin-angiotensin-aldosterone system (RAAS), inflammatory indexes, nutritional status, homocysteine (Hcy), homeostasis model assessment-insulin resistance (HOMA-IR), mineral metabolism, microalbuminuria, and surrogate markers of atherosclerosis [carotid intima media thickness (cIMT), ankle/brachial index (ABI), flow mediated dilation (FMD), renal resistive index (RRI) and left ventricular mass index (LVMI)]. Furthermore, we have carried out the morpho-functional magnetic resonance imaging (MRI) with high-field 3 T Magnetom Avanto.We have divided patients into group A, with normal plasma aldosterone concentration (PAC) and group B with PA, present in 9 (33%) of overall ADPKD patients. Respect to group A, group B showed a significant higher mean value of LVMI, HOMA-IR and Hcy (P = 0.001, P = 0.004, P = 0.018; respectively), and a lower value of FMD and 25-hydroxyvitamin D (25-OH-VitD) (P = 0.037, P = 0.019; respectively) with a higher prevalence of non-dipper pattern at Ambulatory Blood Pressure Monitoring (ABPM) (65% vs 40%, P < 0.05) at an early stage of the disease.In this study, we showed a high prevalence of PA in ADPKD patients, associated to higher LVMI, HOMA-IR, Hcy, lower FMD, and 25-OH-VitD, considered as surrogate markers of atherosclerosis, compared to ADPKD patients with normal PAC values. Our results indicate a higher overall cardiovascular risk in ADPKD patients with inappropriate aldosterone secretion, and a screening for PA in all patients with ADPKD is recommended.
高血压常与常染色体显性多囊肾病（ADPKD）相关，常在肾衰竭发作前被发现，尽管其发病机制尚未完全阐明。ADPKD中的醛固酮增多症可能导致胰岛素抵抗和内皮功能障碍的发展以及心肾疾病的进展。本研究的目的是评估ADPKD患者中原发性醛固酮增多症（PA）的患病率，并确定一些心血管风险的替代生物标志物。我们纳入了27例估计肾小球滤过率（eGFR）≥60 mL/min的高血压ADPKD患者，评估肾素-血管紧张素-醛固酮系统（RAAS）、炎症指标、营养状况、同型半胱氨酸（Hcy）、稳态模型评估-胰岛素抵抗（HOMA-IR）、矿物质代谢、微量白蛋白尿以及动脉粥样硬化的替代标志物[颈动脉内膜中层厚度（cIMT）、踝臂指数（ABI）、血流介导的血管舒张（FMD）、肾阻力指数（RRI）和左心室质量指数（LVMI）]。此外，我们使用3T高场Magnetom Avanto进行了形态功能磁共振成像（MRI）检查。我们将患者分为A组，其血浆醛固酮浓度（PAC）正常，以及B组，患有PA，在所有ADPKD患者中有9例（33%）属于B组。与A组相比，B组的LVMI、HOMA-IR和Hcy的平均值显著更高（分别为P = 0.001、P = 0.004、P = 0.018），而FMD和25-羟基维生素D（2۵-OH-VitD）的值更低（分别为P = 0.037、P = 0.019），在疾病早期动态血压监测（ABPM）中出现非勺型模式的患病率更高（65%对40%，P < 0.05）。在本研究中，我们发现ADPKD患者中PA的患病率较高，与LVMI、HOMA-IR、Hcy升高以及FMD和2۵-OH-VitD降低相关，这些被视为动脉粥样硬化的替代标志物，与PAC值正常的ADPKD患者相比。我们的结果表明，醛固酮分泌异常的ADPKD患者总体心血管风险更高，建议对所有ADPKD患者进行PA筛查。
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