Elevated direct bilirubin: possible predictors for pseudoaldosteronism: case-control study.
Elevated direct bilirubin: possible predictors for pseudoaldosteronism: case-control study.
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DOI：
10.1002/tkm2.1058
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发表时间：
2016-01-01
期刊：
影响因子：
--
通讯作者：
Watanabe, K.
中科院分区：
文献类型：
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作者：
Yoshino, T.;Nakamura, H.;Watanabe, K.
目的：伪醛固酮增多症是甘草的一种已知副作用，日本传统的甘草药是日本甘草的主要使用领域之一。多药耐药蛋白2(MRP2)功能障碍在假性醛固酮增多症发病中起重要作用。MRP2先天缺陷可导致直接胆红素升高的体质性黄疸。因此，直接胆红素升高可作为MRP2功能障碍的生物标志物。然而，假性醛固酮增多症与直接胆红素升高之间的关系尚未得到研究。因此，本研究的目的是评估直接胆红素升高与低钾血症的关系，低钾血症是假性醛固酮增多症的重要特征。方法：这项回顾性观察研究包括2008年5月至2015年3月间首次到庆应大学医院坎波诊所就诊的患者。纳入标准为Kampo配方，包括两周内服用的甘草，以及有关直接胆红素和血钾变化的实验室数据。结果：243例患者(男57例，女186例)的数据被用于分析。平均年龄52.016.2岁。低钾血症3例(1.3%)，其中直接胆红素升高2例(0.9%)。另一名低钾血症患者因使用环状利尿剂而被诊断为假性巴特综合征。其余患者均无低钾血症或直接胆红素升高(P=0.0001，Fisher‘s精确检验)。结论：直接胆红素升高是假性醛固酮增多症的重要预测指标。
Aim: Pseudoaldosteronism is a known side-effect of licorice, and Japanese traditional Kampo medicine is one of the major areas of use of licorice in Japan. Multidrug resistance protein 2 (Mrp2) dysfunction is important for pseudoaldosteronism. Congenital deficiency of Mrp2 causes constitutional jaundice with elevated direct bilirubin. Hence, elevated direct bilirubin can be a biomarker of Mrp2 dysfunction. The relationship between pseudoaldosteronism and elevated direct bilirubin, however, has not been studied as yet. The aim of the present study was therefore to evaluate the relationship between elevated direct bilirubin and hypokalemia, an important characteristic of pseudoaldosteronism. Methods: This retrospective observational study included patients who first visited the Kampo Clinic at Keio University Hospital between May 2008 and March 2015. Inclusion criteria were Kampo formulas including licorice prescribed for >2 weeks, and availability of laboratory data on direct bilirubin and change in serum potassium. Results: Data from 243 patients (57 men, 186 women) were used in the analysis. Mean age was 52.016.2 years. Hypokalemia was noted in three patients (1.3%), among whom elevated direct bilirubin was noted in two (0.9%). The remaining patient with hypokalemia was diagnosed with pseudo-Bartter's syndrome because of loop diuretic use. The remaining 240 patients had neither hypokalemia nor elevated direct bilirubin (P=0.0001, Fisher's exact test). Conclusion: Elevated direct bilirubin is an important predictor of pseudoaldosteronism.