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題 名 | Prognostic Factors of Primary Aldosteronism=原發性醛酮症之預後因素 |
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作 者 | 歐宴泉; 楊啟瑞; 張吉隆; 張兆祥; 吳錫金; 賀昊中; 林合興; 張元耀; | 書刊名 | 中華醫學雜誌 |
卷 期 | 57:2 1996.02[民85.02] |
頁 次 | 頁118-123 |
分類號 | 416.273 |
關鍵詞 | 腎上腺切除術; 腎上腺皮質; 醛酮過高症; 腫瘤; Adrenalectomy; Adrenal cortex; Hyperaldosteronism; Neoplasms; |
語 文 | 英文(English) |
中文摘要 | 背景 原發性醛症是造成高血壓很少見但是可以根治的原因之一。從 民國71年10月至83年11月,共有30例原發性醛症接受單側腎上腺切除術後 達60.3個月的長期追蹤。十九例(佔 63.3%)達到治癒(屬第一組),十一例(佔36.7%) 達到改善(屬第二組)。本研究的目的是探討那些預後因素可用來預測醛症術後 的結果。 方法 本研究回溯分析兩組病人的年齡、性別、高血壓的期間,有否高血壓的 家族史、術前之血壓、醛濃度、腎素活性以及spironolactone藥物對血壓的療效。 高血壓引起終末器官的病變(包括腎臟、心臟、視網膜及腦),腎上腺及腎臟的 病理也加以評估。 結果 第二組病人高血壓的期間比第一組病人長(8.18+/-4.94年比5.21+/-4.24 年)。對spironolactone有療效的在第一組有81.8%,在第二組有16.7%。腎上腺 皮質腺瘤有24例,其中治癒率達70.8%(17/24)。腎上腺皮質大結節增生有6例, 其中治癒率達53.3%(2/6)。第二組病患有較多的終末器官病變。兩組之腎臟切片, 病理變化相似。 結論 本研究認為術前血壓對Spironolactone治療有效,可預測術後治癒機率較 大。較長期間以及2個或2個以上終末器官病變均是不好的預後因素。腎上腺 皮質腺瘤術後有非常高的治癒率,而腎上腺皮質大結節增生的治癒率較低。 |
英文摘要 | Background. Primary aldosteronism (PA) is a rare but potentially curable cause of hypertension. Between October 1982 and November 1994, 30 patients of PA received unilateral adrenalectomy with a long-term follow up (mean: 60.3 months). Nineteen (63.3%) cases were cured (Group 1); 11 (36.7%) cases were improved (Group 2). The purpose of this study was to determine prognostic factors after surgery in patients with PA. Methods. A retrospective analysis was performed regarding age and sex of the patients, duration of hypertension, family history of hypertension, preoperative blood pressure, plasma aldosterone concentration (PAC), plasma renin activity (PRA) and efficacy of spironolactone on blood pressure between both groups. End-organs (including kidney, heart, retina and brain) involvement was evaluated and compared. Adrenalectomy and renal biopsy specimen for pathology were similarly evaluated. Results. The duration of hypertension was longer in Group 2 than in Group 1 (8.18 +/- 4.94 vs 5.21 +/- 4.24 years). The efficacy of spironolactone on blood pressure (BP) was positive in 81.8% of Group 1 and 16.7% of Group 2. Adrenal cortical adenoma in 24 cases with a cure rate of 70.8% (17/24) and adrenal cortical macronodular hyperplasia in 6 cases with a cure rate of 33.3% (2/6) were noted. Group 2 had more end-organs involvement than Group 1. The severity of histopathological change of the renal biopsy was similar, Conclusions. This study suggests that preoperative response of blood pressure to spironolactone administration predicts the postoperative prognosis of hypertension in patient with PA. Long duration of hypertension and involvement of two or more end-organs were poor prognostic factors. Excellent results can be achieved by unilateral adrenalectomy in adrenal cortical adenoma and fair results, in adrenal cortical macronodular hyperplasia. |
本系統中英文摘要資訊取自各篇刊載內容。