摘要
目的比较螺内酯单药治疗及小剂量螺内酯联合治疗特发性醛固酮增多症（特醛症）的有效性及安全性。
方法本研究为前瞻性、随机对照研究，经2周洗脱期后，48例特醛症随机分为螺内酯单药治疗及联合治疗组，观察16周血压达标率（血压〈140/90 mmHg, 1 mmHg＝0.133 kPa）及不良反应（男性乳房发育、肾功能不全及高钾血症）发生率。
结果治疗16周，单药治疗组血压达标率为70.8%（17/24），联合治疗组血压达标率为95.8%（23/24），2组差异有统计学意义（P〈0.05）。2组治疗期间均无高钾血症发生。单药治疗组2例出现肾功能不全，5例出现男性乳房发育；而联合治疗组无肾功能不全及男性乳腺发育。
结论小剂量螺内酯联合治疗在有效控制血压、血钾情况下，不增加肾功能不全及男性乳房发育等不良反应，可作为特醛症新一代治疗方案。
ObjectiveThe aim of this study was to compare the efficacy and safety of spironolactone in mono-therapy versus low dose spironolactone in combined-therapy for the treatment of idiopathic hyperaldosteronism（IHA）.
MethodsThis was a prospective and randomized study. After 2 weeks wash out period, 48 patients confirmed IHA were assigned to either spironolactone mono-therapy or low dose spironolactone combined-therapy groups. All patients underwent adrenal venous sampling and showed no lateralization. The primary outcome was the percentage of patients with blood pressure〈140/90 mmHg（1 mmHg=0.133 kPa）at 16 weeks. The other observatory parameters were： the occurrence of gynecomastia, renal insufficiency, and hyperkalemia.
ResultsAt the end of 16 weeks, the patients′ blood pressure were normalized in 17 out of 24 patients（70.8%）in mono-therapy group and in 23 out of 24 patients（95.8%）in combined-therapy group（P〈0.05）. There was no hyperkalemia in both groups. 2 patients and 5 patients in mono-therapy group were observed renal insufficiency and gynecomastia respectively, while no patients in combined-therapy group presented with those side effects.
ConclusionLow dose spironolactone combined-therapy group is more effective to control blood pressure and hypokalemia without increase the occurrence of renal insufficiency or gynecomastia.
作者
蒋怡然
张翠
姜蕾
苏颋为
周薇薇
王卫庆
Jiang Yiran;Zhang Cui;fiang Lei;Su Tingwei;Zhou weiwei;Wang Weiqing(Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, Chin)
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2018年第6期479-484,共6页
Chinese Journal of Endocrinology and Metabolism
基金
国家自然科学基金基因青年科学基金项目(81500609)
