| Objective: 1.Analyzed the etiological composition and the general trend of metabolic abnormalities in hospitalized patients with hypertension in our hospital from January 2013 to October 2011,providing reference for the prevention and treatment of hypertension.2.To summarize the clinical characteristics of Primary aldosteronism(PA)and discuss the application value of Adrenal vein sampling(AVS)in the diagnosis of PA,so as to understand the safety and effectiveness of super-selective Adrenal embolization(SAAE)in the treatment of PA.Methods:According to the ninth edition of internal medicine,we collected the inpatients diagnosed with hypertension in our hospital from January 2013 to October 2018 by using the names of hypertension,Secondary hypertension,adrenal tumor,renal hypertension and other diseases that may cause hypertension as the key words.The diagnosis of Essential hypertension(EH)was based on the 2010 Chinese guidelines for the prevention and treatment of hypertension.The diagnosis of Secondary hypertension(SH)was based on the medical history,physical signs,laboratory and imaging results.Part of this includes histopathological examination.Clinical data,biochemical indicatorsand imaging examination were collected,and the results were statistically analyzed and summarized.The same patient was hospitalized several times and the last hospitalization data was recorded.Patients with undetermined causes of hypertension,drug-induced hypertension,white-coat hypertension,gestational hypertension,concomitant congenital heart disease,malignant tumor,blood system disease,severe infection and incomplete clinical data are excluded.According to the causes of hypertension,EH group and SH group.Results:1.The collected 5799 cases of diagnosis of hospitalized patients with high blood pressure,including EH4376,accounted for 75.7%,SH 1403 cases,accounting for 24.3%.2.In SH,PA accounted for the highest proportion(45.8%),followed by renal essential hypertension(43.7%),pheochromocytoma/paraganglioma(3.9%),corticocytosis(3.6%),and renal vascular hypertension(1.5%).3.Male patients in EH group,positive family history of hypertension,high TG,low HDL,mixed hyperlipidemia,abnormal blood glucose metabolism,overweight and obesity were all higher than those in SH group.The age of SH group was lower than that of EH group.There was no significant difference between the two groups in the association of high TC and high LDL(P > 0.05).4.Among the 4.643 PA patients,females were more than males,51.1% of whom were hypokalemic.PA was associated with overweight,obesity and abnormal lipid metabolism.Imaging suggested that unilateral adrenal mass was predominant.5.Combined with the clinical manifestations,diagnosis test and imaging results,the cause of clinical diagnosis of PA including aldosterone adenoma,285(44.3%),idiopathic aldosteronism 178 cases(27.7%),74 cases of hyperplasia(11.5%),uncertain etiology of 106 cases(16.5%).Of the 276 PA patients who underwent surgery,242(87.7%)had adenoma and 34(12.3%)had hyperplasia,and the coincidence rate of imaging findings and pathology was 86.2%.6.There were 143 cases of AVS examination for PA patients who could not determine the dominant side clinically,among which 116 cases were intubated successfully,with a success rate of 81.1%,4 cases had partial data loss,and a total of 112 cases had complete data.Imaging showed that 51 cases had unilateral and 17 cases had bilateral occupying lesions,and 44 cases had no occupying lesions.Combination of AVS as a result,the left side of the edge secretion 24 cases(17 cases of unilateral,bilateral in 2 cases,found no lesions in5 cases),the right side of the edge secretion of 37 cases(19 cases unilateral,bilateral 7 cases,lesions are not found in 11 cases),51 cases with no dominant side(15 cases of unilateral,bilateral 8 cases,28 cases found no lesions),unilateral advantages and imaging coincidence rate 61.8%,no dominant side with imaging coincidence rate was 54.9%.After the improvement of AVS examination,a total of 10 cases of PA underwent surgery,and the imaging findings of 6 cases of unilateral mass occupation(diameter: 0.8~2.9cm)were consistent with the location of AVS.Postoperative pathology confirmed adenoma in 5 cases and hyperplasia in 1 case.Finally,AVS results suggested unilateral dominant secretion and surgical treatment,and pathological results showed two cases of adenoma and two cases of hyperplasia,with improved blood pressure and potassium after operation.7.PA treatment: among the 643 PA patients,drug treatment was 50.7%(326cases,161 cases of teraldehyde,56 cases of hyperplasia,43 cases of adenoma,62 cases of unknown etiology),surgical operation was 42.3%(272 cases,222 cases of adenoma,12 cases of hyperplasia,38 cases of unknown etiology),SAAE accounted for 6.4%(41 cases,17 cases of teraldehyde,12 cases of adenoma,6 cases of hyperplasia,6 cases of unknown etiology),and 0.6%(4cases of adenoma)patients underwent both SAAE and surgery.8.There were 13 PA patients after SAAE with complete follow-up data,including 6 males and 7 females,aged 32 to 59 years old,with the duration of hypertension ranging from 2 months to 10 years,including 2 cases of aldosterone tumor,2 cases of unilateral hyperplasia,and 9 cases of teraldehyde.Up to 6 months,found that 3 cases(adenomas,hyperplasia,1 case),aldehyde postoperative did not take any blood pressure medication,blood pressure to maintain in the normal range,9 cases(8 cases,aldehyde,1 case of hyperplasia)postoperative use 1 kind of CCB medications to control blood pressure,blood pressure control,1 case of aldosterone adenoma 6 months after three kinds of antihypertensive drugs to control blood pressure.The levels of aldosterone and serum sodium decreased after SAAE compared with that before SAAE,and the differences were statistically significant(P < 0.05),while the differences of systolic blood pressure,diastolic blood pressure,renin and serum potassium were not statistically significant(P > 0.05).Conclusion:1.EH is still the main cause of hypertension,but SH occupies an important proportion.And hypertension is often associated with a variety of metabolic abnormalities,should be routine examination and early intervention.2.The detection rate of PA in SH group was the highest(45.8%).For patients with hypertension,hypokalemia and adrenal mass,the possibility of PA should be vigilant.3.The types of PA are aldosteronoma and teraldehyde,which are the most common types.4.AVS has certain value in PA diagnostic typing,especially in patients with small tumor and bilateral adrenal gland occupying,AVS examination can be used as a supplement to imaging examination.However,the sample size of this study is limited,so it is necessary to expand the sample size for further verification.5.Surgical treatment and surgical resection are recommended to be the first choice for patients with aldosterone tumor with definite qualitative and localized diagnosis.SAAE is safe and effective in the treatment of PA,and may be more effective in the treatment of patients with teraldehyde,but the number of cases is small,and the long-term efficacy remains to be observed. |
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