BiLiGe WuYun, Wang Chaoqi, Bao JiRiGaLa, Yu Dahai, Min A, Hong Zhi, Chen Xiangbao, Wang Min, Wang Dongmei
Department of Urology, Affiliated Hospital of Inner Mongolia University for the Nationlities.
Medical College of Inner Mongolia University for the Nationlities, Tongliao, P.R. China.
Medicine (Baltimore). 2019 Jul;98(30):e16611. doi: 10.1097/MD.0000000000016611.
Although unilateral primary aldosteronism (PA) is the most common surgically correctable cause of hypertension, the cure rate varies widely. The predicting factors related to uncured hypertension are not completely established. This study was designed to determine predicting factors associated with resolution of hypertension after adrenalectomy for PA.The records of unilateral PA patients who had undergone retroperitoneal laparoscopic adrenalectomy were retrospectively reviewed from January 2010 to December 2017 in a single center. Patient demographics and preoperative factors were analyzed, including age, sex, smoking history, family history of hypertension, the presence of diabetes, body mass index (BMI), systolic blood pressure, diastolic blood pressure, biochemical results and tumor characteristics. Univariate and multivariate Logistic regression analysis were used for statistical assessment.126 patients with unilateral PA were enrolled, and the mean age at the time of surgery was 54.2 years. Of these patients, 74 (58.7%) were women, and the mean BMI and duration of hypertension were 26 kg/m and 61 months, respectively. Hypertension was cured in 46% patients, of the patients with uncured hypertension, 91% had improved control of hypertension. In univariate analysis, age (P = .03), BMI (P = .01), duration of hypertension >5 years (P = .03), preoperative antihypertensive agents>2 (P = .02), contralateral abnormalities (P = .03) were the main factors related to uncured hypertension after adrenalectomy. In multivariate regression analysis, uncured hypertension was independently associated with obesity (25.00-29.99: odds ratio [OR], 2.97, P < .02; ≥30: OR, 6.42, P < .01), duration of hypertension >5 years (OR, 6.25, P < .01), preoperative antihypertensive agents >2 (OR, 5.30, P < .001), and contralateral adrenal abnormalities (OR, 8.38, P < .01).The hypertension cure rate of unilateral adrenalectomy in PA is not high. Obesity, duration of hypertension >5 years, preoperative antihypertensive agents >2 and contralateral adrenal abnormalities were independently associated with uncured hypertension.
虽然单侧原发性醛固酮增多症（PA）是高血压最常见的可通过手术纠正的病因，但治愈率差异很大。与高血压未治愈相关的预测因素尚未完全明确。本研究旨在确定PA患者肾上腺切除术后高血压缓解的相关预测因素。对2010年1月至2017年12月在单中心接受腹膜后腹腔镜肾上腺切除术的单侧PA患者的记录进行回顾性分析。分析患者的人口统计学和术前因素，包括年龄、性别、吸烟史、高血压家族史、糖尿病的存在、体重指数（BMI）、收缩压、舒张压、生化结果和肿瘤特征。采用单因素和多因素Logistic回归分析进行统计学评估。纳入126例单侧PA患者，手术时的平均年龄为54.2岁。其中，74例（58.7%）为女性，平均BMI和高血压病程分别为26kg/m²和61个月。46%的患者高血压得到治愈，在高血压未治愈的患者中，91%的患者高血压控制情况有所改善。单因素分析中，年龄（P = 0.03）、BMI（P = 0.01）、高血压病程>5年（P = 0.03）、术前使用降压药>2种（P = 0.02）、对侧异常（P = 0.03）是肾上腺切除术后高血压未治愈的主要相关因素。多因素回归分析中，高血压未治愈与肥胖（25.00 - 29.99：比值比[OR]，2.97，P < 0.02；≥30：OR，6.42，P < 0.01）、高血压病程>5年（OR，6.25，P < 0.01）、术前使用降压药>2种（OR，5.30，P < 0.001）以及对侧肾上腺异常（OR，8.38，P < 0.01）独立相关。PA患者单侧肾上腺切除术的高血压治愈率不高。肥胖、高血压病程>5年、术前使用降压药>2种以及对侧肾上腺异常与高血压未治愈独立相关。
