探讨高血压合并糖尿病住院患者中原发性醛固酮增多症(PA)的筛检流程、检出率以及特殊治疗后疗效的观察。

回顾收集178例于2008年8月至2009年8月就诊于新疆维吾尔自治区人民医院高血压科的高血压合并糖尿病的住院患者，178例患者均已行常规坐位肾素、醛固酮浓度(PAC)测定、生化检测及人体学测量。满足坐位PAC/肾素活性值≥554 pmol/L·[μg/(L·h)]^－1患者被列为初筛阳性组，其余为初筛阴性组；初筛阳性组患者被建议行盐水输注试验，试验后PAC被抑制到138.5 pmol/L以下者排除PA，不被抑制在277 pmol/L以下者确诊为PA，其余患者需要结合临床确诊。

(1)48例初筛阳性组与130例阴性组比较，阳性组血钾[(3.7±0.4)mmol/L]低于阴性组[(3.9±0.4)mmol/L]，差异有统计学意义(t＝－3.40，P<0.01)；(2)41例初筛阳性经盐水负荷试验后PA>138.5 pmol/L，占23.0%；其中25例负荷盐水后PAC≥277.0 pmol/L可确诊PA，检出率为14.0%；(3)41例患者中有23例接受了肾上腺静脉取血术(AVS)，21例取血成功，操作成功率91.3%，其中6例定诊为单侧型PA，3例行单侧肾上腺病变切除术，其中2例术后病理证实为醛固酮瘤，1例为单侧肾上腺结节样增生；(4)23例已行AVS的PA患者经手术或盐皮质激素受体拮抗剂治疗后随访1～2年，与其治疗前比较，收缩压[(132.0±7.7)mmHg]低于治疗前[(150.0±14.0)mmHg]，差异有统计学意义(t＝5.63，P<0.01)；舒张压[(85.0±7.0)mmHg]低于治疗前[(96.0±5.0)mmHg]，差异有统计学意义(t＝5.16，P<0.01)；血钾[(4.0±0.3)mmol/L]高于治疗前[(3.5±0.4)mmol/L]，差异有统计学意义(t＝－5.45，P<0.01)。

在高血压合并糖尿病患者中存在相当数量的PA，建议积极规范筛检及管理，针对病因施以特殊治疗，疗效肯定。

To explore the screening, positive rate and curative effect observation after special treatment for primary aldosteronism (PA) in hypertensive in-patients with diabetes mellitus.

One hundred and seventy-eight hypertensive in-patients with diabetes were screened for PA.Patients with aldosterone/renin acrivity ≥554 pmol/L·[μg/(L·h)]^-1 were defined the positive screening group, and remains were the negative screening group.PA was considered according on plasma aldosterone concentration (PAC) ≥138.5 pmol/L and PA was defined with PAC≥277.0 pmol/L after saline infusion test in the positive screening group.

The level of potassium [(3.7±0.4)mmol/L] in the positive screening group was lower than that [(3.9±0.4)mmol/L] in the negative group, and the difference was statistically significant (t=-3.40, P<0.01). The prevalence of PA ranged from 14.0% to 23.0% respectively, due to 41 PA patients with PAC≥138.5 pmol/L and 25 PA patients with PAC≥277.0 pmol/L.Twenty-three patients with PA accepted the adrenal vein sampling (AVS), the operative successful ratio was 91.3%, 6 patients were defined on unilateral adrenal PA, 3 patients accepted adrenalectomy, 2 patients with adrenal producing adenoma and one patient with unilateral nodule hyperplasia were identified via the pathological diagnose after surgery.Twenty-three patients with PA, who had been performed AVS, were followed up 1~2 years after having accepted surgery or mineralocorticoid receptor antagonist.The level of systolic blood pressure [(132.0±7.67)mmHg] after treatment was lower than that [(150.0±14.0)mmHg] before treatment, the difference was statistically significant (t=5.63, P<0.01). The level of diastolic blood pressure [(85.0±7.0)mmHg] after treatment was lower than that [(96.0±5.0)mmHg] before treatment, and the difference was statistically significant (t=5.16, P<0.01). The level of potassium [(4.0±0.3)mmol/L] after treatment was higher than that [(3.5±0.4)mmol/L] before treatment, and the difference was statistically significant (t=-5.45, P<0.01).

A considerable amount PA patients exist in hypertensive subjects with diabetes mellitus.Screening and management for PA are suggested in these patients and the curative effect is affirmed.