Watanabe Daisuke, Morimoto Satoshi, Morishima Noriko, Ichihara Atsuhiro
Division of Hormonal Medicine and Bioregulatory Science, Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Endocrine. 2025 Feb 15. doi: 10.1007/s12020-025-04193-z.
Primary aldosteronism (PA) can be classified into aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) and is related to chronic inflammatory diseases. We compared lymphocyte-based inflammatory indices among patients with APA, IHA and essential hypertension (EH), and investigated the relationships between these indices and background factors in patients with PA.
A total of 186 patients (39 with APA, 48 with IHA, and 99 with blood-pressure-matched EH) were retrospectively included. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated as lymphocyte-based inflammatory indices.
Lymphocyte count was lower in the APA group than in the IHA and EH groups. NLR and PLR were significantly higher in the APA group than in the IHA and EH groups. In the APA group, NLR correlated positively with plasma aldosterone concentration after the saline infusion test, while in the IHA group, NLR correlated positively with body mass index and negatively with flow-mediated dilation. Lymphocyte-based inflammatory indices did not differ significantly between KCNJ5-mutant and wild-type groups. NLR, MLR, and PLR remained unchanged from baseline to 1 week after adrenalectomy (ADX), but a cut-off baseline MLR of 0.18 was predictive of complete clinical success after ADX (sensitivity, 0.8095; specificity, 0.7222; area under the curve, 0.719).
Lymphocyte-based inflammatory indices showed distinct patterns in patients with APA and IHA. This study provides a better understanding of the implications of complete blood cell counts in patients with PA.
原发性醛固酮增多症（PA）可分为醛固酮瘤（APA）和特发性醛固酮增多症（IHA），且与慢性炎症性疾病相关。我们比较了APA、IHA和原发性高血压（EH）患者基于淋巴细胞的炎症指标，并研究了这些指标与PA患者背景因素之间的关系。
回顾性纳入186例患者（39例APA患者、48例IHA患者和99例血压匹配的EH患者）。计算中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和单核细胞与淋巴细胞比值（MLR）作为基于淋巴细胞的炎症指标。
APA组的淋巴细胞计数低于IHA组和EH组。APA组的NLR和PLR显著高于IHA组和EH组。在APA组中，盐水输注试验后NLR与血浆醛固酮浓度呈正相关，而在IHA组中，NLR与体重指数呈正相关，与血流介导的血管舒张呈负相关。基于淋巴细胞的炎症指标在KCNJ5突变型和野生型组之间无显著差异。肾上腺切除术后（ADX），NLR、MLR和PLR从基线到术后1周保持不变，但基线MLR的临界值为0.18可预测ADX术后的临床完全缓解（敏感性，0.8095；特异性，0.7222；曲线下面积，0.719）。
基于淋巴细胞的炎症指标在APA和IHA患者中表现出不同模式。本研究有助于更好地理解PA患者全血细胞计数的意义。
