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目的探讨原发性醛固酮增多症(简称“原醛症”)患者肾上腺腺瘤手术前后胰岛B细胞功能的变化。方法北京协和医院内分泌科2004—2006年收治的17例原醛症患者,接受肾上腺腺瘤摘除术前后均进行标准的75g葡萄糖耐量试验,分析胰岛素抵抗指数,HOMA分泌功能指数、胰岛素曲线下面积(INSAUC)胰岛素和血糖增量之比(ΔI30/ΔG30)等指标的变化以及和血钾、血浆醛固酮的相关关系。结果ΔI30/ΔG30在术后明显升高(P=0.01),按体重指数(BMI)≥25分层后肥胖或超重组术后ΔI30/ΔG30增加不明显(P=0.08);术前低血钾的患者术后胰岛B细胞分泌功能明显改善,而术前血钾正常者改善不明显。手术前后INSAUC变化和空腹血钾正相关(r=0.71,P=0.01),和醛固酮水平的变化以及随访时间无明显相关。结论原醛症患者肾上腺腺瘤摘除术后低血钾纠正,胰岛B细胞的分泌功能改善,其改善程度受术前血钾和体重的影响。
Objective To investigate the changes of islet B cell function before and after adrenal adenoma in patients with primary aldosteronism (“primary aldosteronism”). Methods Seventy patients with primary aldosteronism who were treated in Department of Endocrinology, Peking Union Medical College Hospital from 2004 to 2006 underwent standard 75g glucose tolerance test before and after adrenal adenoma excision. Insulin resistance index, HOMA secretion index, area under the curve of insulin (INSAUC) insulin and blood glucose increased the ratio (ΔI30 / ΔG30) and other indicators of change and serum potassium, plasma aldosterone. Results The postoperative ΔI30 / ΔG30 was significantly increased (P = 0.01). The increase of ΔI30 / ΔG30 in obese or overweight group was not obvious (P = 0.08) after stratified by body mass index (BMI) Of patients with postoperative pancreatic islet B cell secretion improved significantly, while preoperative serum potassium did not improve significantly. The change of INSAUC before and after surgery was positively correlated with fasting serum potassium (r = 0.71, P = 0.01), but not with the change of aldosterone level and the follow-up time. Conclusion Hypokalemia is corrected after adrenal adenoma excision in primary aldosteronism patients, and the secretion of pancreatic islet B cells is improved. The improvement is affected by preoperative serum potassium and body weight.