How should we treat patients with primary aldosteronism to prevent new-onset diabetes mellitus?
How should we treat patients with primary aldosteronism to prevent new-onset diabetes mellitus?
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原发性醛固酮增多症患者如何预防新发糖尿病？
DOI：
10.1097/hjh.0000000000001440
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发表时间：
2017
期刊：
影响因子：
4.9
通讯作者：
Nishiyama Akira
中科院分区：
文献类型：
--
作者：
Hitomi Hirofumi;Nishiyama Akira
先前的临床报告表明，原发性醛固酮增多症可能是葡萄糖不耐受的原因，并且可能是糖尿病的原因[1-3]。然而，尚未进行一项长期、大规模的观察性研究来检查原发性醛固酮增多症患者糖尿病的发病情况，并且特别缺乏与治疗方案（包括手术和药物干预）相关的数据。以往的基础研究表明醛固酮不仅控制血压和电解质平衡，还参与糖代谢[4]。尽管这些基础研究阐明了高醛固酮水平下葡萄糖代谢的分子机制，但缺乏阐明新发糖尿病（NODM）参与的临床试验，并且治疗方案在原发性醛固酮增多症患者中预防NODM的效果仍存在争议。 Wu 等人的清晰、有趣的研究[5]本期《高血压杂志》旨在调查原发性醛固酮增多症患者中高醛固酮浓度与 NODM 的长期关联。此外，还比较了接受手术切除产生醛固酮的腺瘤（APA）的患者和接受盐皮质激素受体拮抗剂（MRA）药物治疗的患者之间的NODM风险。Wu等人。利用 1997 年至 2009 年台湾国民健康保险 (NHI) 研究数据库记录设计了一项人口研究。国民健康保险计划是一项全国性保险计划，登记了几乎所有台湾人口（2009 年为 2312 万）的门诊就诊、住院、干预和疾病概况。首先，吴等人。确定了 2367 名原发性醛固酮增多症患者，他们在诊断前未接受过任何抗糖尿病药物治疗，其中包括 9468 名主要患者
Previous clinical reports have revealed that primary aldosteronism is a possible cause of glucose intolerance and might be a cause of diabetes mellitus [1–3]. However, a long-term, large-scale observation study examining the onset of diabetes mellitus among patients with primary aldosteronism has not been conducted, and data related to treatment options, including surgical and pharmacological interventions, are particularly lacking. Previous basic studies have demonstrated that aldosterone not only controls blood pressure and electrolyte balance, but also is involved in glucose metabolism [4]. Although these basic studies clarified the molecular mechanism of glucose metabolism at high aldosterone levels, clinical trials to elucidate the involvement of new onset of diabetes mellitus (NODM) are lacking and the effects of therapeutic options to prevent NODM in patients with primary aldosteronism remain controversial. The clear, interesting study by Wu et al.[5] in this issue of the Journal of Hypertension aimed to investigate the longterm association of high aldosterone concentration with NODM among primary aldosteronism patients. In addition, the risk of NODM was compared between patients who underwent surgical resection of aldosterone-producing adenoma (APA) and those who received pharmacological treatment with a mineralocorticoid receptor antagonist (MRA).Wu et al. designed a population study using Taiwan National Health Insurance (NHI) research database records from 1997 to 2009. The NHI program is a nationwide insurance program that registers outpatient visits, hospital admissions, interventions, and disease profiles in almost all the population of Taiwan (23.12 million in 2009). First, Wu et al. identified 2367 patients with primary aldosteronism who had not received treatment with any antidiabetic agents before diagnosis, and included 9468 essential