不同血钾水平原发性醛固酮增多症患者健康状况评估

目的: 研究不同血钾水平原发性醛固酮增多症(简称原醛症)患者的整体健康状况。方法: 入选原醛症患者359例，根据血钾水平分为正常血钾组和低血钾组，比较两组患者一般临床资料、相关血生化指标、超声心动图检查指标，采用社区人群功能状态测定量表COOP/WONCA评估两组原醛症患者的健康状况。 结果： 低血钾组血浆醛固酮浓度显著高于正常血钾组（P<0.01）；两组间左室收缩末期直径（LVSD）、左心室舒张末期直径（LVDD）、左室后壁厚度（LVPW）、室间隔厚度（IVS）、左室射血分数（LVEF）无显著差异（P>0.05）;而低血钾组左心室质量指数（LVMI）显著高于正常血钾组（P=0.032）；以LVMI为因变量行多元回归分析显示，收缩压、血浆醛固酮浓度、血钾对LVMI的影响具有统计学意义（P<0.05）。统计COOP/WONCA功能状态测定量表分数显示， 低血钾组体能、日常活动、健康变化、整体健康的得分显著高于正常血钾组（P<0.01），而情绪、社交活动、疼痛得分与正常血钾组无明显差异（P>0.05）。结论： 低血钾原醛症患者整体健康状况低于正常血钾原醛症，需要重视对原醛症尤其伴低血钾患者早期积极药物及手术干预治疗。

Evaluation the health status of primary aldosteronism patients with different serum potassium level

Objective: To study the whole health condition of primary aldosteronism（PA） patients with different serum potassium level. Methods: Three hundred fifty-nine primary aldosteronism patients were enrolled and divided into normal serum potassium PA group and hypopotassemia PA group. The general clinical characteristics, related biochemical parameters indexes, echocardiographic examinations were collected in all subjects, COOP/WONCA function status scale were conducted to evaluate the health condition between the two groups. Results: The plasma aldosterone concentration in hypopotassemia patients was higher than that in normal serum potassium (P<0.01); there were no significant difference between the two groups in left ventricular diastolic diameter, left ventricular posterior wall thickness, interventricular septum thickness and left ventricular ejection fraction. Left ventricular mass index（LVMI） was markedly increased in hypopotassemia PA group compared with normal serum potassium PA group(P=0.032). Multiple regression analysis with LVMI as dependent variable showed that the effect of systolic pressure, plasma aldosterone and serum potassium on LVMI was statistically significant(P<0.05). The result statistics fraction of COOP/WONCA function status scale showed that four aspects(physical agility, daily activities, health change, whole health condition) were significantly different in hypopotassemia PA group compared with normal serum potassium PA group(P<0.01). There were no significant difference in other three aspects (emotion, social activities, pains) between hypopotassemia PA group and normal serum potassium PA group(P>0.05). Conclusion: The whole health condition of hypopotassemia PA group were worse than that of normal serum potassium PA group. Therefore, early active medication and surgical intervention should be very important for the PA patients. ［Key words］primary aldosteronism; serum potassium; left ventricular mass index; COOP/WONCA function status scale