标题：以急性缺血性脑卒中为首发症状的高血压患者中原发性醛固酮增多症的筛查结果分析

      作者：王义云，郑启东，杨梦摇    玉环市第二人民医院内二科，浙江 玉环 317600

      卷次： 2023年34卷23期

      【摘要】 目的 了解浙江玉环地区以急性缺血性脑卒中为首发症状的高血压患者中原发性醛固酮增多症(PA)的患病情况，分析其临床特点。方法 选取2018年1月至2022年12月玉环市第二人民医院住院部收治的150例以急性缺血性脑卒中为首发症状的高血压患者进行PA筛查，于清晨8:00~10:00行非卧位醛固酮及肾素活性检测，计算醛固酮肾素比值(ARR)，ARR阳性患者给予盐水负荷试验，盐水负荷试验阳性者确诊PA，PA患者行肾上腺CT扫描评估肾上腺形态。结果 150例患者中共筛查出PA患者23例(15.33%)，PA中合并低钾血症8例(34.78%)，CT提示肾上腺腺瘤 4例(17.39%)，双侧肾上腺增生 13例(56.52%)，单侧肾上腺增生 5例(21.74%)，而1例(4.35%)患者肾上腺CT无明显病变。PA中3级高血压20例(86.96%)，2级高血压3例(13.04%)。结论 浙江玉环地区以急性缺血性脑卒中为首发症状的高血压患者中PA的患病率为15.33%，PA中3级高血压比例高达86.96%，低钾血症的比例仅为34.78%，肾上腺影像学中腺瘤、双侧肾上腺增生、单侧肾上腺增生的比例分别为39.13%、34.78%、21.74%。
      【关键词】 浙江；玉环；缺血性卒中；筛查；原发性醛固酮增多症；临床特点
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2023）23—3389—03

Analysis of screening results of primary aldosteronism in hypertensive patients with acute ischemic stroke as thefirst symptom.
WANG Yi-yun, ZHENG Qi-dong, YANG Meng-yao. Department of Internal Medicine Ⅱ, the SecondPeople's Hospital of Yuhuan, Yuhuan 317600, Zhejiang, CHINA
【Abstract】 Objective To investigate the incidence of primary aldosteronism (PA) in hypertensive patients withacute ischemic stroke as the first symptom in Yuhuan, Zhejiang Province, and to analyze its clinical characteristics.Methods A total of 150 hypertensive patients with acute ischemic stroke as the first symptom admitted to the InpatientDepartment of the Second People's Hospital of Yuhuan from January 2018 to December 2022 were selected for PAscreening. Non-recumbent position aldosterone and renin activities were detected from 8:00 to 10:00 in the morn-ing, and aldosterone renin ratio (ARR) was calculated. Patients with positive ARR were given saline load test, andpatients positive in saline load test was confirmed as PA. Adrenal morphology was evaluated by CT scan in pa-tients with PA. Results Among the 150 patients, 23 (15.33%) were diagnosed with PA, 8 (34.78%) were combinedwith hypokalemia, 4 (17.39%) were diagnosed with adrenal adenoma by CT, 13 (56.52%) were diagnosed with bilateraladrenal hyperplasia, and 5 (21.74%) were diagnosed with unilateral adrenal hyperplasia. There was no obvious adrenalCT lesion in 1 patient (4.35%). There were 20 patients (86.96%) with grade 3 hypertension and 3 patients (13.04%) withgrade 2 hypertension in PA. Conclusion In Yuhuan area of Zhejiang Province, the prevalence rate of PA among hyper-tensive patients with acute ischemic stroke as the first symptom was 15.33%, the proportion of grade 3 hypertension inpatients with PA was as high as 86.96%, and the proportion of hypokalemia was only 34.78%. The proportions of adeno-ma, bilateral adrenal hyperplasia and unilateral adrenal hyperplasia were 39.13%, 34.78%, and 21.74%, respectively.
      【Key words】 Zhejiang; Yuhuan; Ischemic stroke; Screening; Primary aldosteronism; Clinical features