Prognosis of primary aldosteronism in Japan: results from a nationwide epidemiological study
Prognosis of primary aldosteronism in Japan: results from a nationwide epidemiological study
复制标题
DOI：
10.1507/endocrj.ej13-0353
复制
发表时间：
2014-01-01
影响因子：
2
通讯作者：
Yanase, Toshihiko
中科院分区：
文献类型：
--
作者：
Miyake, Yoshihiro;Tanaka, Keiko;Yanase, Toshihiko
日本肾上腺激素紊乱研究委员会对原发性醛固酮增多症（PA）进行了一项全国性流行病学研究。本研究作为本研究的一部分，旨在揭示治疗类型与PA预后之间的关系。在初步调查中，4161例PA患者在2003年1月1日至2007年12月31日期间，从3252个内科，儿科和泌尿外科报告。在二次调查中，向在初次调查中报告患者的科室发送了一份问卷，要求提供个体患者的详细临床信息。本研究共获得了1706例PA患者的数据。在双侧或单侧醛固酮腺瘤患者中，在调整了检查预后时的年龄、性别、手术治疗和药物治疗后，手术治疗与高血压的改善显著相关（校正比值比[OR]：0.47 [95%置信区间（CI）：0.29-0.77]）和低钾血症（校正OR：0.17 [95% CI：0.11-0.29]）。在这组患者中，未观察到药物治疗与此类预后之间的显著关系。在双侧或单侧肾上腺皮质增生患者中，手术治疗而非药物治疗与低钾血症的改善显著相关（校正OR：0.23 [95%CI：0.06-0.74]），而手术或药物治疗与高血压的预后无关。总之，在高血压和低钾血症方面，手术提供了比药物更好的PA预后，但在研究期间没有新的抗醛固酮药物依普利酮。
The Research Committee of Disorders of Adrenal Hormones, Japan, undertook a nationwide epidemiological study of primary aldosteronism (PA). The present study was undertaken as a part of this study to reveal the relationship between type of treatment and the prognosis of PA. In the primary survey, 4161 patients with PA during the period January 1, 2003-December 31, 2007 were reported from 3252 departments of internal medicine, pediatrics and urology. In the secondary survey, a questionnaire that requested detailed clinical information on individual patients was sent to those departments reporting patients in the primary survey. In total, data on 1706 patients with PA were available in the present study. Among patients with bilateral or unilateral aldosterone-producing adenoma, after adjustment for age at which prognosis was examined, sex, surgical treatment and medical treatment, surgical treatment was significantly associated with amelioration of hypertension (adjusted odds ratio [OR]: 0.47 [95% confidence interval (Cl): 0.29-0.77]) and hypokalemia (adjusted OR: 0.17 [95% CI: 0.11-0.29]). No significant relationship was observed between medical treatment and such prognosis in this group of patients. Among patients with bilateral or unilateral adrenal hyperplasia, surgical, but not medical, treatment was significantly associated with amelioration of hypokalemia (adjusted OR: 0.23 [95% CI: 0.06-0.74]), while there was no relationship between surgical or medical treatment and the prognosis of hypertension. In conclusion, surgery offered a better prognosis of PA than medication with regards to hypertension and hypokalemia, with the limitation that a new anti-aldosterone drug, eplerenone, was not available during the study period.