糖尿病临床研究

　　【摘要】目的 分析功能性肾上腺皮质腺瘤患者MS的患病情况及术后改变。 方法 对65例肾上腺醛固酮瘤(APA组)、43例皮质醇瘤(CSA组)及24例无功能瘤(NAA组)患者行MS相关指标检测，同时检测激素水平及生化测值，将所得结果与53例原发性高血压(EH组)患者及58名正常对照者(NC组)进行比较。对APA、CSA及NAA组行肾上腺肿瘤摘除术，术后再次随访激素及MS相关测值，与术前结果进行比较。 结果 (1)上述各组MS患病率分别为38.5%、41.9%、20.8%、24.5%及17.5%。(2)将APA、CSA组分别分为伴或不伴MS亚组，APA组伴MS亚组血醛固酮高于同组不伴MS亚组; CSA组伴MS亚组8:00及24:00血皮质醇高于CSA组不伴MS亚组。(3)APA组术后血、尿醛固酮下降，血钾则升高;CSA组术后8:00、24:00血、尿皮质醇下降，8:00血ACTH升高;NAA组激素测值手术前后比较差异无统计学意义。(3)APA、CSA及NAA组术后MS患病率分为27.7%、27.9%及29.2%。APA组术后SBP[(170.0±19.4) vs (145.0±20.7)mmHg]及DBP[(103.6±10.1) vs (81.5±10.3)mmHg]下降(P<0.05);CSA组术后SBP[(148.1±18.9) vs (139.3±16.2) mmHg]下降(P<0.05);NAA组MS相关测值手术前后比较差异无统计学意义(P>0.05)。结论 功能性肾上腺皮质腺瘤患者MS患病率升高，且其原因与肾上腺皮质激素的高分泌相关。手术摘除肿瘤，激素高分泌状态解除后，患者MS的各项症状得以改善。

　　【关键词】肾上腺皮质腺瘤;醛固酮瘤;皮质醇瘤;代谢综合征;高血糖症

　　【Abstract】Objective To investigate changes of metabolic syndrome (MS) in patients with adrenocortical adenoma(ACA). Methods Sixty-five patients with aldosterone producing adenoma (APA), 43 patients with cortisol-secreting adenoma (CSA) and 24 patients with nonfunctional adrenal adenoma (NAA) were evaluated. Body Mass Index (BMI), blood pressure, plasma lipid, fasting and 2 h postprandial plasma glucose, plasma and urinary aldosterone, plasma potassium, basic and upright plasma renin activity (PRA), plasma and urinary cortisol, plasma ACTH and plasma potassium ACA were examined and compared with those from 53 patients of essential hypertension (EH) and 58 controls. Adrenalectomy was performed for all the patients with adrenocortical adenoma. The data after operation were compared with those before operation. Results ① The prevalence of MS was 38.5%, 41.9%, 20.8%, 24.5% and 17.5% in the groups respectively. The prevalence of obesity/overweight was higher in CSA group than in the other groups. There were 44.6% patients with hyperglycemia in APA group, and 48.8% in CSA group. The prevalence of hypertension was the highest in APA and EH Group, followed by CSA Group, NAA and control Groups. There were 55.4% patients with lipid disturbance in APA group, and 46.5% in CSA group. ② We divided all APA and CSA patients into groups with or without MS. The APA patients with MS had higher plasma aldosterone than those without MS. The CSA patients with MS had higher 8:00 and 24:00 plasma cortisol than those without MS. ③After operation, the plasma and urinary aldosterone were decreased and the plasma potassium was increased in APA patients. The 08:00, 24:00 plasma cortisol and urinary cortisol were decreased and the 8:00 plasma ACTH was increased in CSA patients. There were no significant differences in hormonal measurements of NAA patients before and after operation. ④The prevalence of MS was 27.7%, 27.9% and 29.2% in three groups after operation. The systolic and diastolic blood pressures were decreased in APA patients after operation, and the systolic blood pressure decreased in CSA patients. There was no significant difference in MS measurements of NAA patients before and after operation. Conclusions Our study indicates that patients with functional adrenocortical adenoma have a significantly higher prevalence of metabolic syndrome which is related to over secretion of adrenal cortex hormone. After operation, accompanying normalization of hormonal secretion, the condition of MS in functional adrenocortical adenoma patients is improved.

　　【Key words】Adrenocortical adenoma;Aldosteronoma;Cortisol-secreting adenoma;Metabolic syndrome;Hyperglycemia