原发性醛固酮增多症患者中非酒精性脂肪性肝病与低钾血症。
Non-Alcoholic Fatty Liver Disease and Hypokalemia in Primary Aldosteronism Among Chinese Population.
机构信息
Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
出版信息
Front Endocrinol (Lausanne). 2021 Apr 22;12:565714. doi: 10.3389/fendo.2021.565714. eCollection 2021.
BACKGROUND
In recent years, evidence that aldosteronism is a risk factor for metabolic disorders has increased. This study was designed to investigate the role of nonalcoholic fatty liver disease (NAFLD) and hypokalemia in primary aldosteronism (PA).
METHODS
A total of 222 patients diagnosed with PA and 222 non-PA patients were included in our study. Demographic data, medical histories, clinical evaluations, complete blood counts, serum biochemical analyses, aldosterone and potassium levels were obtained. Data are presented as the means ± standard deviation (SD). To compare the parameters between cases and controls, Student's t-tests or Mann-Whitney U tests were used for continuous variables, and χ2 tests were used for categorical variables. Pearson correlation analysis was used to define relationships between pairs of parameters. A two-sided < 0.05 was considered statistically significant. Multivariate logistic regression was performed to assess the independent effects of potassium and other metabolic variables on NAFLD in PA patients.
RESULTS
The diagnosis of NAFLD was more common in PA patients (n=222, 35.1%) than in non-PA subjects (29.7%). PA patients with and without NAFLD had similar metabolic imbalance characteristics. In PA patients with hypokalemia, relatively higher prevalences of NAFLD (44% vs. 27%, < 0.05) and diabetes mellitus (19.8% vs. 9.9%, < 0.05) were observed. Hypokalemic PA patients had a worse metabolic status than PA patients without hypokalemia, including higher body mass index (BMI) (25.4 ± 3.4 vs. 24.1 ± 3.9 kg/m, < 0.05), more severe dyslipidemia as well as insulin resistance, higher serum uric acid levels (354 ± 95 vs. 319 ± 87 μmol/L, < 0.01) and aggravated inflammation.
CONCLUSION
The prevalence of NAFLD was higher in PA patients than in non-PA patients, although the patterns of obesity, dyslipidemia and insulin resistance were similar. Hypokalemic PA patients had a worse metabolic status than normokalemic PA patients. This study provides new insights that can inform further mechanistic studies about metabolic imbalance in patients with aldosteronism.
背景
近年来，醛固酮增多症是代谢紊乱的危险因素的证据不断增加。本研究旨在探讨非酒精性脂肪性肝病（NAFLD）和低钾血症在原发性醛固酮增多症（PA）中的作用。
方法
共纳入 222 例 PA 患者和 222 例非 PA 患者。获取患者的人口统计学数据、病史、临床评估、全血细胞计数、血清生化分析、醛固酮和钾水平。数据表示为均数±标准差（SD）。为比较病例组和对照组的参数，采用 Student's t 检验或 Mann-Whitney U 检验比较连续变量，采用 χ2 检验比较分类变量。采用 Pearson 相关分析定义参数之间的关系。双侧 P < 0.05 为差异有统计学意义。采用多变量 logistic 回归分析评估钾和其他代谢变量对 PA 患者 NAFLD 的独立影响。
结果
PA 患者（n=222，35.1%）中 NAFLD 的诊断率高于非 PA 患者（29.7%）。PA 患者中，无论是否合并 NAFLD，代谢失衡特征均相似。在低钾血症的 PA 患者中，NAFLD（44% vs. 27%，P < 0.05）和糖尿病（19.8% vs. 9.9%，P < 0.05）的患病率相对较高。低钾血症的 PA 患者的代谢状态比无低钾血症的 PA 患者更差，包括更高的体重指数（BMI）（25.4 ± 3.4 vs. 24.1 ± 3.9 kg/m，P < 0.05）、更严重的血脂异常和胰岛素抵抗、更高的血尿酸水平（354 ± 95 vs. 319 ± 87 μmol/L，P < 0.01）和加重的炎症。
结论
PA 患者中 NAFLD 的患病率高于非 PA 患者，尽管肥胖、血脂异常和胰岛素抵抗的模式相似。低钾血症的 PA 患者的代谢状态比正常血钾的 PA 患者更差。本研究提供了新的见解，可以为醛固酮增多症患者代谢失衡的进一步机制研究提供信息。
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