Huang-Fu Y C, DU Y Q, Yu L P, Xu T
Department of Urology, Peking University People' s Hospital, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2022 Aug 18;54(4):686-691. doi: 10.19723/j.issn.1671-167X.2022.04.017.
To analyze the risk factors of persistent hypertension in patients who underwent adrenalectomy for primary aldosteronism and to evaluate the predictive value of the aldosteronoma resolution score (ARS) scoring system for surgical outcomes of adrenalectomy for primary aldosteronism.
We reviewed the clinical characteristics of patients who underwent adrenalectomy for primary aldosteronism from 2018 to 2021 at Peking University People' s Hospital to recognize risk factors of uncured hypertension after surgery. Based on the patient' s clinical outcomes, the patients were divided into complete success group and partial/absent success group. Risk factors for persistent hypertension were analyzed. The value of the ARS scoring system was assessed by the area under the curve ().
In this study, 112 patients were included. Most of the patients benefited from the surgery for 94.6% were a complete or partial clinical success after follow-up for at least 6 months. According to postoperative hypertension status, the patients were divided into complete success group (51 cases) and partial/absent success group (61 cases). There were statistical differences between the two groups in age, body mass index (BMI), waist circumference, duration of hypertension, number of preoperative antihypertension medications, preoperative systolic blood pressure, history of diabetes, history of cardiovascular and cerebrovascular diseases, serum creatinine, estimated glomerular filtration rate(eGFR), high-density lipoprotein cholesterol and triglyceride. Logistic regression analysis showed that age (=1.111, 95%: 1.029-1.199), waist circumference (=1.073, 95% 1.013-1.137), pre-operative systolic blood pressure (=1.033, 95%: 1.008-1.060) and history of cardiovascular and cerebrovascular diseases (=16.061, 95%: 1.312-196.612) were the risk factors for uncured hypertension in primary aldosteronism patients after surgery, but female gender not. The median ARS in the complete success group was 4 and in the partial/absent success group, it was 2. Among the patients with ARS of 4-5, the cure rate of hypertension was 76.5%. The area under the curve of ARS was 0.743.
The history of cardiovascular and cerebrovascular diseases is a significant risk factor for persistent hypertension after surgery in primary aldosteronism patients. ARS scoring system has a certain value in predicting the postoperative hypertension status of primary aldosteronism patients. However, further research is still needed on a prediction model for surgical outcomes of primary aldosteronism which is more suitable for the Chinese population is still needed.
分析原发性醛固酮增多症患者行肾上腺切除术后持续性高血压的危险因素，并评估醛固酮瘤消退评分（ARS）系统对原发性醛固酮增多症肾上腺切除术手术结局的预测价值。
回顾2018年至2021年在北京大学人民医院行肾上腺切除术治疗原发性醛固酮增多症患者的临床特征，以识别术后高血压未治愈的危险因素。根据患者的临床结局，将患者分为完全成功组和部分/无成功组。分析持续性高血压的危险因素。通过曲线下面积（）评估ARS评分系统的价值。
本研究共纳入112例患者。大多数患者从手术中获益，94.6%的患者在至少随访6个月后获得完全或部分临床成功。根据术后高血压状态，将患者分为完全成功组（51例）和部分/无成功组（61例）。两组在年龄、体重指数（BMI）、腰围、高血压病程、术前抗高血压药物数量、术前收缩压、糖尿病史、心脑血管疾病史、血清肌酐、估算肾小球滤过率（eGFR）、高密度脂蛋白胆固醇和甘油三酯方面存在统计学差异。Logistic回归分析显示，年龄（=1.111，95%：1.029 - 1.199）、腰围（=1.073，95% 1.013 - 1.137）、术前收缩压（=1.033，95%：1.008 - 1.060）和心脑血管疾病史（=16.061，95%：1.312 - 196.612）是原发性醛固酮增多症患者术后高血压未治愈的危险因素，但女性不是。完全成功组的ARS中位数为4，部分/无成功组为2。在ARS为4 - 5的患者中，高血压治愈率为76.5%。ARS的曲线下面积为0.743。
心脑血管疾病史是原发性醛固酮增多症患者术后持续性高血压的重要危险因素。ARS评分系统在预测原发性醛固酮增多症患者术后高血压状态方面具有一定价值。然而，仍需要进一步研究更适合中国人群的原发性醛固酮增多症手术结局预测模型。
