Lancet Diabetes Endo:单侧肾上腺切除的原发性醛固酮增多症效果评价

2017-06-01 zhangfan MedSci原创

大多数患者从肾上腺切除术中获益,年轻患者和女性患者更容易获得良好的手术结果

单侧原发性醛固酮增多症是最常见的高血压可手术纠正因素,但目前尚缺少评价手术效果的标准。近日研究人员创建了相关单侧原发性醛固酮增多症肾上腺切除后的临床及生化效果标准。

名为PASO的单侧原发性醛固酮增多症肾上腺切除后的疗效共识标准国际项目,由来自28个医疗中心31名国际专家构成通过对诊断为原发性醛固酮增多症单侧总肾上腺切除术患者的结果资料进行回顾性研究随访分析建立相应标准。在标准的基础上,研究人员确定达到完整的,部分的或不存在的临床和生化受益的比例。使用逻辑回归分析以确定术前相关因素与临床和生化受益间的关系。

根据血压,抗高血压药物史,血钾和醛固酮浓度,血浆肾素浓度及活动制定了6项相关标准以及2项后续评估标准。国际队列分析中,研究人员分析了1994年-2015年间705名患者临床信息,其中,259例(37%)的患者完全临床受益,部分受益者334人(47%)。生化指标完全受益者656人(94%)。女性,年轻患者临床完全受益的比例更高;术前用药导致临床效果变差。

这次标准是建立在现有患者手术治疗成功的基础上并得到了多个国际临床队列分析的验证。大多数患者从肾上腺切除术中获益,年轻患者和女性患者更容易获得良好的手术结果。

原始出处:


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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205277, encodeId=d9e52052e725, content=大多数患者从肾上腺切除术中获益,年轻患者和女性患者更容易获得良好的手术结果。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Jun 01 15:39:06 CST 2017, time=2017-06-01, status=1, ipAttribution=)]
    2018-03-31 howi
  5. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205277, encodeId=d9e52052e725, content=大多数患者从肾上腺切除术中获益,年轻患者和女性患者更容易获得良好的手术结果。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Jun 01 15:39:06 CST 2017, time=2017-06-01, status=1, ipAttribution=)]
  6. 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  7. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205277, encodeId=d9e52052e725, content=大多数患者从肾上腺切除术中获益,年轻患者和女性患者更容易获得良好的手术结果。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Jun 01 15:39:06 CST 2017, time=2017-06-01, status=1, ipAttribution=)]
  8. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205277, encodeId=d9e52052e725, content=大多数患者从肾上腺切除术中获益,年轻患者和女性患者更容易获得良好的手术结果。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Jun 01 15:39:06 CST 2017, time=2017-06-01, status=1, ipAttribution=)]
    2017-06-03 cmsvly
  9. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205277, encodeId=d9e52052e725, content=大多数患者从肾上腺切除术中获益,年轻患者和女性患者更容易获得良好的手术结果。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Jun 01 15:39:06 CST 2017, time=2017-06-01, status=1, ipAttribution=)]
    2017-06-03 huagfeg
  10. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205277, encodeId=d9e52052e725, content=大多数患者从肾上腺切除术中获益,年轻患者和女性患者更容易获得良好的手术结果。, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7cJ6ejWUr2nIia8qOvAKNdLHr32Df6G8iaoaOx6pHaoiacwp26DaslxZHCGbibZhhCGven4rvmWP60GahtzgFjgCjR/0, createdBy=6b111703011, createdName=有备才能无患, createdTime=Thu Jun 01 15:39:06 CST 2017, time=2017-06-01, status=1, ipAttribution=)]
    2017-06-01 有备才能无患

    大多数患者从肾上腺切除术中获益,年轻患者和女性患者更容易获得良好的手术结果。

    0

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在这项大型队列研究中,经腹腔镜确诊的子宫内膜异位症与高胆固醇血症和高血压风险增加之间存在前瞻性的相关性。相反,高胆固醇血症和高血压也与较高的经腹腔镜确诊的子宫内膜异位症的发生风险之间存在前瞻性的相关性。

J Hypertens:替米沙坦比氢氯噻嗪降舒张压更优

对于饮食喜咸,多药联合依从性又不好的轻中度高血压患者,采用单药治疗效果如何?近期,北京大学医学部乔治健康研究所和北京大学人民医院学者发表于J Hypertens上的一项研究表明,对于这部分患者,每天40 mg的替米沙坦或25 mg的氢氯噻嗪都有效,而前者降压效果明显更好,尤其是舒张压。研究显示,在接受替米沙坦或氢氯噻嗪的两组轻中度高血压患者,治疗后15天、30天和60天时,替米沙坦组平均收缩压/舒

J Hypertens:高血压患者常规尿液检测抗高血压药物治疗依从性分析!

这些结果表明门诊就诊患者有良好的抗高血压药物治疗依从性。研究人员认为通过超高效液相色谱-串联质谱法的抗高血压药物尿液检测是一个准确、实用的直接监测服药依从性的工具。这种直接的信息与自我报告的问卷并不重叠。

JAMA Intern Med:强化降压对老年人步态速度和移动限制有何影响?

目标收缩压低于120 mm Hg对年龄≥75岁高血压老人的步态速度有影响吗?2017年4月,发表在《JAMA Intern Med》的一项有2636例个体的随机临床试验表明,在3年的随访期内,强化降压(目标收缩压小于120 mm Hg)和标准治疗(目标收缩压小于140 mm Hg)在步态速度和移动限制方面没有差异。重要性:强化血压(BP)控制对心血管发病率和死亡率显示获益;其是否会对身体功能结局产

J Hypertens:原发性高血压患者抗高血压药物依从性的影响因素分析!

由此可见,几个患者因素被确认作为抗高血压类药物类别和治疗依从性的决定因素;因此,它们可以帮助确定有不依从性风险的患者,因此可以针对它们进行依从性改善干预。

BMJ:55岁前发生的高血压遗传,心血管死亡风险更高

波士顿大学医学院研究人员分析了弗明汉心脏研究中两代受试者的高血压发病及心血管死亡情况表明:早发(<55岁)高血压与其子女发生高血压密切相关,而且与晚发高血压相比,早发高血压的心血管死亡风险更高。研究者发现,如果父母中有一位或者两位是早发高血压,子女患高血压风险分别增加1倍和2.5倍。而晚发高血压患者的子女患高血压风险与无高血压者子女相当。本研究数据显示,在父辈这一代3614例受试者中,随访6