Ichikawa S, Tajima Y, Sakamaki T, Matsuo H, Kogure M, Hirano Y, Yagi S, Murata K
Jpn Circ J. 1984 Nov;48(11):1184-96. doi: 10.1253/jcj.48.1184.
Plasma volume (PV) and extracellular fluid volume (ECF) were determined in 7 patients with essential hypertension (controls) and in 10 patients with primary aldosteronism, while on a high Na diet (342 mEq/day) and on a low Na diet (12 mEq/day). The volume studies were repeated in 6 of the primary aldosteronism patients during treatment with spironolactone for over 3 months. Plasma renin activity (PRA), plasma aldosterone concentration (PAC), cortisol concentration, and serum Na and K concentrations were measured in all patients while on a Na-restricted diet (85 mEq/day) as well as on high-Na and low-Na diets. There were no significant changes in arterial pressure during different Na diets in any groups of patients with essential hypertension, or primary aldosteronism with and without spironolactone therapy. Spironolactone treatment normalized the arterial pressure in patients with primary aldosteronism at all Na intakes. These patients had greater values for PV and ECF than did those with essential hypertension. Spironolactone treatment reduced PV during the low-Na diet, but did not alter it during the high-Na diet. Spironolactone did not produce significant changes in ECF during either the high-Na or low-Na diets. Although there were no changes in PV and ECF in patients with primary aldosteronism due to changes in Na intake, both PV and ECF were significantly less in these patients during spironolactone treatment and in patients with essential hypertension during low-Na intake than during high-Na intake. With primary aldosteronism, PRA was depressed and PAC was elevated when compared to essential hypertension, these were not altered by different Na diets in the patients with primary aldosteronism as they were in those with essential hypertension. During treatment with spironolactone the PRA was restored to normal and showed normal changes with variations in dietary Na, but PAC remained elevated during spironolactone. Plasma cortisol was the same among those with essential hypertension and patients with untreated and spironolactone-treated primary aldosteronism. Serum K was less in untreated primary aldosteronism during all Na diets than in essential hypertension, but during spironolactone it was restored to normal. These results suggest that in primary aldosteronism the reduction in arterial pressure by spironolactone treatment does not occur simply by reductions in body fluid volumes. The long-term treatment of patients with primary aldosteronism with spironolactone does not inhibit the production of aldosterone, possibly because of enhanced activity of the renin-angiotensin system and an increase in serum K.
在7例原发性高血压患者（对照组）和10例原发性醛固酮增多症患者中，测定了高钠饮食（342 mEq/天）和低钠饮食（12 mEq/天）时的血浆容量（PV）和细胞外液容量（ECF）。6例原发性醛固酮增多症患者在接受螺内酯治疗3个月以上期间重复进行了容量研究。在所有患者钠限制饮食（85 mEq/天）以及高钠和低钠饮食时，测量了血浆肾素活性（PRA）、血浆醛固酮浓度（PAC）、皮质醇浓度以及血清钠和钾浓度。在原发性高血压患者、接受或未接受螺内酯治疗的原发性醛固酮增多症患者的任何组中，不同钠饮食期间动脉压均无显著变化。螺内酯治疗使原发性醛固酮增多症患者在所有钠摄入量时的动脉压恢复正常。这些患者的PV和ECF值高于原发性高血压患者。螺内酯治疗在低钠饮食时降低了PV，但在高钠饮食时未改变PV。在高钠或低钠饮食期间，螺内酯对ECF均未产生显著变化。尽管原发性醛固酮增多症患者因钠摄入量变化导致PV和ECF无变化，但在螺内酯治疗期间这些患者以及原发性高血压患者在低钠摄入时的PV和ECF均显著低于高钠摄入时。对于原发性醛固酮增多症，与原发性高血压相比，PRA降低而PAC升高，原发性醛固酮增多症患者中不同钠饮食并未像原发性高血压患者那样改变这些指标。在螺内酯治疗期间，PRA恢复正常并随饮食钠变化呈现正常改变，但螺内酯治疗期间PAC仍升高。原发性高血压患者、未治疗和接受螺内酯治疗的原发性醛固酮增多症患者的血浆皮质醇相同。在所有钠饮食时，未治疗的原发性醛固酮增多症患者的血清钾低于原发性高血压患者，但在螺内酯治疗期间恢复正常。这些结果表明，在原发性醛固酮增多症中，螺内酯治疗降低动脉压并非仅仅通过减少体液量实现。原发性醛固酮增多症患者长期使用螺内酯治疗并未抑制醛固酮的产生，可能是由于肾素 - 血管紧张素系统活性增强以及血清钾升高。
