Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Hypertens Res. 2023 Sep;46(9):2213-2227. doi: 10.1038/s41440-023-01375-y. Epub 2023 Jul 18.
The relationship of KCNJ5 mutation with vascular function and vascular structure in aldosterone-producing adenoma (APA) patients before and after adrenalectomy remains unclear. The purpose of this study was to evaluate the influence of KCNJ5 mutation on vascular function and vascular structure in APA and the effects of adrenalectomy on vascular function and vascular structure in APA patients with and those without KCNJ5 mutation. Flow-mediated vasodilation (FMD), nitroglycerine-induced vasodilation (NID), brachial artery intima-media thickness (IMT), and brachial-ankle pulse wave velocity (baPWV) were measured to assess vascular function and vascular structure in 46 APA patients with KCNJ5 mutation and 23 APA patients without KCNJ5 mutation and in 69 matched pairs of patients with essential hypertension (EHT). FMD, NID, brachial IMT and baPVW were evacuated before adrenalectomy and at 12 weeks after adrenalectomy in APA patients with KCNJ5 mutation and APA patients without KCNJ5 mutation. FMD and NID were significantly lower in APA patients than in patients with EHT. There was no significant difference in FMD or NID between patients with and those without KCNJ5 mutation. In APA patients with KCNJ5 mutation, FMD and NID after adrenalectomy were significantly higher than those before adrenalectomy. In APA patients without KCNJ5 mutation, only NID after adrenalectomy was significantly higher than that before adrenalectomy. Endothelial function in APA patients with KCNJ5 mutation was improved by adrenalectomy in the early postoperative period. KCNJ5 mutation is a predictor for early resolution of endothelial function by adrenalectomy. This study was approved by principal authorities and ethical issues in Japan (URL for Clinical Trial: http://www.umin.ac.jp/ctr/index.htm Registration Number for Clinical Trial: UMIN000003409).
醛固酮瘤（APA）患者肾上腺切除术前和术后 KCNJ5 突变与血管功能和血管结构的关系尚不清楚。本研究旨在评估 KCNJ5 突变对 APA 患者血管功能和血管结构的影响，以及肾上腺切除术对 KCNJ5 突变和无 KCNJ5 突变的 APA 患者血管功能和血管结构的影响。通过测量血流介导的血管扩张（FMD）、硝酸甘油诱导的血管扩张（NID）、肱动脉内膜中层厚度（IMT）和肱踝脉搏波速度（baPWV）来评估 46 例 KCNJ5 突变的 APA 患者、23 例无 KCNJ5 突变的 APA 患者和 69 例匹配的原发性高血压（EHT）患者的血管功能和血管结构。在 KCNJ5 突变的 APA 患者和无 KCNJ5 突变的 APA 患者中，在肾上腺切除术前和肾上腺切除术后 12 周测量 FMD、NID、肱动脉 IMT 和 baPWV。与 EHT 患者相比，APA 患者的 FMD 和 NID 明显较低。有 KCNJ5 突变和无 KCNJ5 突变的患者之间的 FMD 或 NID 没有显著差异。在 KCNJ5 突变的 APA 患者中，肾上腺切除术后的 FMD 和 NID 明显高于肾上腺切除术前。在无 KCNJ5 突变的 APA 患者中，只有肾上腺切除术后的 NID 明显高于肾上腺切除术前。KCNJ5 突变的 APA 患者术后早期，肾上腺切除术可改善内皮功能。KCNJ5 突变是肾上腺切除术早期内皮功能恢复的预测因子。本研究已获得日本主要当局和伦理问题的批准（临床试验网址：http://www.umin.ac.jp/ctr/index.htm 临床试验注册号：UMIN000003409）。
