Influential Factor For Prognosis Of Patients With Primary Aldosteronism After Adrenalectomy And Study On Association Of Angiotensin II Receptor Type2Gene Polymorphism Rs5194with Primary Aldosteronism

Primary aldosteronism was induced by the excessive and autonomous secretion ofaldosterone by the adrenal gland，and was characterized by hypertension，inhibitsrenin activity，hyperaldosteronism in urinary and blood，hypokalemia，that waswidespread considered curable form of secondary hypertension. Hyperaldosteronismin Primary aldosteronism may give rise to the serious cardiovascular and renalcomplication.Activity treatment should block the pathophysiological role ofaldosteronism，improve cure rates and reduce the incidence of complication. Theresearch aim to discuss from two parts：the occurrence and evolution of Primaryaldosteronism and the prognostic factors.That facilitated the clinical treatment andguide prognosis，and paid attention to the application of correlating genes inmolecular genetics.Part OneInfluential factor for prognosis of patients with Primary aldosteronism afteradrenalectomyObjective To investigate the influential factor for the recovery of blood pressure ofpatients with primary aldosteronism after adrenalectomy.Method The clinical andfollow up data（6-36months）of patients with primary aldosteronism，who underwentadrenalectomy between January2009and March2012were analyzedretrospectively.Factors which would likely influence the outcome of prognosis werecollected，and those which showed statistical significance by One-Way ANOVAanalysis were screened，followed by further logistic regression analysis to obtain theindependent factor which were related to outcome of these patients.Result Amongthe93patients with primary aldosteronism after adrenalectomy，according theimaging study and pathology result，59patients with adrenocortical adenomas （63.44%），27patients with unilateral adrenal hyperplasia（29.03%），as well as7patients with Idiopathic hyperplasia （7.52%）； however， clinically curablehypertension was found in43patients，47patients were clinically ameliorating，and in3patients whose were no obvious improvement.The logistic regression analysisfinally showed these independent factors：years of diagnosing hypertension，grade ofhypertension after receiving medical treatment，Aldosterone-to-renin ratio before thesurgery.Conclusion Considering the aforementioned independent factors which wererelated to the recovery of blood pressure，when the urologists plan to adrenalectomyin patients，and then strength the follow-up and life style intervention，in order toimprove the comprehensive treatment.Part TwoStudy on association of Angiotensin II receptor type2gene polymorphism rs5194with Primary aldosteronismObjective To investigate the correlation between the single nucleotidepolymorphisms (SNPs) of rs5194site in Angiotensin II receptor type2gene andsusceptibility to primary aldosteronism. Method By the case-control study，usingMGB-Taqman probe technology to detect SNPs genotyping in284patients withprimary aldosteronism group and250normal controls；Chi-Square test was used todetect the differences in the distribution of genetype in case-control groups；therelative risk was analyzed with non-conditional Logistic regression analysis.Result：The genotype frequency in PHs patients and controls of GG，AA，GA were35.2%、25%、39.8%and45.6%、15.6%、38.8%respectively．There was a significantdifference in the frequency of genotype between the two groups (P＜0.05)．Therisk of suffering from PH in person carrying homozygous AA was higher than that inperson carrying GG genotype (OR=1.821,95%CI=1.232-2.691); and the incidenceof heterozygous GA was also higher.(OR=1.165,95%CI=0.888-1.528).ConclusionThe rs5195genetype in angiotensin II receptor type2was related to the risk ofprimary aldosteronism，and was considered that Allele A (Adenine)in genetype couldincrease relative risk of sufferingFrom primary aldosteronism. Otherwise, Allele G （Guanine）in genetype has a protective effect in the disease.