| ObjectiveTo improve the understanding of primary aldosteronism,and analyze the improvement of blood pressure and related factors after operation.MethodsWe selected 122 patients with primary aldosteronism in Fujian Province Hospital from January 2005 to December 2017,excluded bilateral adrenal hyperplasia of idiopathic hyperaldosteronism,all patients were treated by surgery,and the surgical method was performed by laparoscopic resection of adrenal lesions or most resection,postoperative pathology confirmed the diagnosis of adrenocortical adenoma or unilateral adrenal hyperplasia.we recorded the clinical data,including general clinical data,biochemical indicators and pathological results.According to the follow-up blood pressure level at least 3 months after surgery,the whole subjects were divided into two groups,the postoperative normal blood pressure group and postoperative hypertension group,analyzed and compared the difference of preoperative clinical data between 2 groups,with P<0.05 for the difference was statistically significant.The Logistic regression analysis was used to further analyze the factors affecting postoperative blood pressure improvement.Results1.The 122 patients had higher blood pressure and the prevalence rate of hypertension was 100%,blood pressure range(140—260/90—165)mmHg,the average blood pressure(182±22/110±13)mmHg,including 2 cases of grade 1 hypertension(1.64%),25 patients with grade 2 hypertension(20.49%),grade 3 hypertension in 95 cases(77.87%).In addition to 18 cases(14.75%),the serum potassium level was in normal range,and the rest were lower than normal,with the lowest level of 1.1mmol/L,and the average(2.55±0.75)mmol/L.There were 72 cases(59.02%)who had thickening of interventricular septum,44 cases(36.07%)with left ventricular hypertrophy,and 2 cases(1.64%)with coronary heart disease.Cerebrovascular disease was found in 5 cases.Renal insufficiency was found in 14 cases.2.The postoperative blood pressure of all patients was significantly decreased compared with the preoperative,postoperative serum potassium level returned to normal.According to the results of blood pressure in the postoperative follow-up,divided into 76 cases(62.30%)postoperative normal blood pressure group,46 cases(37.70%)postoperative hypertension group,the 2 groups in gender,age,BMI,duration of hypertension,family history of hypertension,preoperative use of spironolactone,preoperative 3 day average systolic blood pressure,TG,HDL-C,BUN and CREA,UA,eGFR,IVSTD,LVMI,there was significant difference(P < 0.05).Whether the preoperative use of spironolactone therapy to preoperative 3 day average systolic pressure、diastolic pressure is no significant difference(P > 0.05),but the improvement of blood pressure after operation in the 2 groups had significant difference(P < 0.05).3.The Logistic regression analysis showed that age,duration of hypertension,family history of hypertension,preoperative use of spironolactone,preoperative 3day average systolic blood pressure were the influence factors of hypertension after surgery,age,duration of hypertension,family history of hypertension,preoperative 3 day average systolic blood pressure were the risk factors,preoperative use of spironolactone was the protective factor(age: β=0.077,OR=1.080;b=0.017,OR=1.017;duration of hypertension: hypertension family history: β=1.511,OR=4.530;preoperative 3 day average systolic blood pressure: β=0.084,OR=1.088;preoperative use of spironolactone: β=-1.679,OR=0.186).ConclusionsPatients with adrenocortical adenoma and primary unilateral adrenocortical hyperplasia have been treated with surgical treatment,and the effect is significant.Spironolactone has an antagonistic effect of aldosterone,for the preoperative preparation of ideal drug.Older age,hypertension duration,positive family history of hypertension,preoperative non-use of spironolactone,preoperative 3 day average systolic blood pressure were the important factors affecting postoperative blood pressure improvement. |
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