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目的分析和比较两型原发性醛固酮增多症(PA)患者胰岛素敏感性及其治疗前后胰岛素敏感性与病情的关系。方法本院确诊PA患者32例,其中肾上腺皮质腺瘤(APA)20例,特发性醛固酮增多症(IHA)12例,观察治疗前后体质量指数、血压、血浆醛固酮、空腹血糖、空腹胰岛素及胰岛素抵抗指数(HOMA-IR)等指标的变化。结果PA组患者治疗后收缩压[(140±8.6)mmHg]、舒张压[(82±9)mmHg]、空腹胰岛素[(7.6±1.8)mmol/L)]、空腹血糖[(5.0±0.7)mmol/L]、HOMA-IR(1.6±0.4)均低于治疗前[收缩压(178±10)mmHg、舒张压(105±11)mmHg、空腹胰岛素(10±3)mmol/L、空腹血糖(5.6±1.1)mmol/L、HOMA-IR(2.4±0.9),均P<0.01];治疗前IHA组血浆醛固酮水平[(228±52)ng/L]低于治疗前APA组[(344±41)ng/L,P<0.01)];治疗前IHA组胰岛素抵抗患者所占百分率(58%)显著高于APA组(20%,P<0.05);APA手术组醛固酮水平(82±23)ng/L低于治疗前[(344±41)ng/L,P<0.01)];治疗后APA组血钾(4.0±0.4)mmol/L、HIA组血钾(4.1±0.4)mmol/L分别较治疗前[(3.2±0.4)mmol/L、(3.4±0.3)mmol/L]高(P<0.01)。结论PA患者部分存在胰岛素抵抗。PA患者在进行肾上腺腺瘤切除或应用螺内酯治疗后胰岛素敏感性可有一定程度恢复。
Objective To analyze and compare the insulin sensitivity of two types of patients with primary aldosteronism (PA) and its relationship with insulin sensitivity before and after treatment. Methods Thirty-two PA patients were diagnosed in our hospital, including 20 cases of adrenocortical adenoma (APA) and 12 cases of idiopathic aldosteronism (IHA). The body mass index, blood pressure, plasma aldosterone, fasting blood glucose, fasting insulin Insulin resistance index (HOMA-IR) and other indicators of change. Results After treatment, the systolic blood pressure (140 ± 8.6) mmHg, diastolic blood pressure (82 ± 9) mmHg and fasting insulin (7.6 ± 1.8) mmol / L) in fasting plasma glucose group [(5.0 ± 0.7) mmol / L] and HOMA-IR (1.6 ± 0.4) were lower than before treatment [systolic blood pressure (178 ± 10) mmHg, diastolic blood pressure (105 ± 11) mmHg, fasting insulin (5.6 ± 1.1) mmol / L, HOMA-IR (2.4 ± 0.9), all P <0.01]. The level of plasma aldosterone in IHA group before treatment was (228 ± 52) ng / L, ± 41) ng / L, P <0.01). The percentage of insulin resistance in IHA group before treatment was significantly higher than that in APA group (58% vs 20%, P <0.05) ) was significantly lower than that before treatment [(344 ± 41) ng / L, P <0.01). After treatment, the levels of serum potassium (4.0 ± 0.4) mmol / L were significantly higher than those before treatment [(3.2 ± 0.4) mmol / L, (3.4 ± 0.3) mmol / L] (P <0.01). Conclusion Some PA patients have insulin resistance. PA patients after adrenal adenoma resection or application of spironolactone insulin sensitivity may have a certain degree of recovery.