Yoshida Yuichi, Kinouchi Kenichiro, Nagai Satoshi, Sakima Atsushi, Takami Yoichi, Arima Hisatomi, Miyashita Kazutoshi, Mukoyama Masashi
Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Japan.
Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Hypertens Res. 2025 Jul 4. doi: 10.1038/s41440-025-02273-1.
To date, no systematic review has examined whether adrenalectomy (ADX) or mineralocorticoid receptor antagonist (MRA) treatment is more effective in patients with unilateral primary aldosteronism (uPA). Comparing clinical and biochemical data before and after treatment, we performed a systematic review to determine whether either ADX or MRA treatment is superior to the other in patients with uPA. Article search was performed using the PubMed, Cochrane Library, and ICHUSHI electronic databases. A comparative analysis was performed when at least 3 articles were available in each outcome. The collected data were used to calculate the effect measures represented as mean difference (MD) or odds ratio (OR). Our search strategy identified 526 abstracts, of which 7 research papers were finally included in the analysis. ADX for uPA patients significantly reduced the incidence of cerebro-cardiovascular disease (OR 0.63 [95% confidence interval 0.46, 0.85]), lowered the systolic BP (-8.78 mmHg [-11.61, -5.95]), and increased the serum potassium levels (0.43 mmol/L [0.35, 0.51]) compared to MRAs. In conclusion, ADX is more effective than MRA treatment in patients with uPA, but with higher risk of increased serum potassium levels. Graphical abstract: ADX adrenalectomy, MRAs mineralocorticoid receptor antagonists, PA primary aldosteronism, SBP systolic blood pressure.
迄今为止，尚无系统评价研究肾上腺切除术（ADX）或盐皮质激素受体拮抗剂（MRA）治疗对单侧原发性醛固酮增多症（uPA）患者是否更有效。通过比较治疗前后的临床和生化数据，我们进行了一项系统评价，以确定在uPA患者中，ADX或MRA治疗是否优于另一种治疗。使用PubMed、Cochrane图书馆和ICHUSHI电子数据库进行文献检索。当每个结局至少有3篇文章时进行比较分析。收集的数据用于计算以平均差（MD）或比值比（OR）表示的效应量。我们的检索策略共识别出526篇摘要，其中7篇研究论文最终纳入分析。与MRA相比，uPA患者接受ADX可显著降低心脑血管疾病的发生率（OR 0.6三[95%置信区间三.46，三.85]），降低收缩压（-8.78 mmHg[-11.61，-5.95]），并提高血清钾水平（0.43 mmol/L[0.35，0.51]）。总之，在uPA患者中，ADX比MRA治疗更有效，但血清钾水平升高的风险更高。图摘要：ADX肾上腺切除术，MRA盐皮质激素受体拮抗剂，PA原发性醛固酮增多症，SBP收缩压。
