南京医科大学第一附属医院内分泌科
江苏省科技计划专项资金（基础研究计划自然科学基金）青年基金项目
目的：探索基线血清脂联素和瘦素与原发性醛固酮增多症（primary aldosteronism, PA）靶器官损害和术后临床转归的相关性。方法：纳入68例行单侧肾上腺切除术且有术后至少6个月随访信息的PA患者，检测患者基线血清脂联素和瘦素浓度，依据PA手术结局（primary aldosteronism surgical outcome, PASO）标准进行术后临床转归分型，分析脂联素和瘦素与靶器官损害指标和不同术后分型的相关性。结果：28例（41.2%）PA患者术后临床治愈，40例（58.8%）临床未治愈。临床治愈组基线脂联素和估算的肾小球滤过率（estimated glomerular filtration rate, eGFR）水平均高于临床未治愈组（均P<0.05），身体质量指数（body mass index, BMI）、高血压药物限定日剂量值、高脂血症占比和糖尿病占比低于临床未治愈组（均P<0.05），两组间瘦素水平无差异。瘦素水平与心脏彩超指标二尖瓣舒张早期E峰峰值速度/舒张晚期A峰峰值速度比值和踝肱指数呈负相关（均P<0.05），脂联素水平与靶器官损害指标无相关。多因素逐步Logistic回归分析显示，低BMI（OR=0.422，95% CI 0.272-0.653，P<0.001）和高脂联素（OR=1.359，95%CI 1.004-1.840，P=0.047）水平与临床治愈独立相关。进一步按BMI分层，在非肥胖PA患者中高eGFR（OR=1.074，95% CI 1.023-1.127，P=0.004）和高脂联素（OR=1.816，95% CI 1.261-2.616，P=0.001）水平与临床治愈有关。结论：基线血清脂联素和瘦素检测有助于评估PA靶器官损害，预测术后临床转归，协助指导PA精准管理。
Objective: To investigate the correlation of baseline serum adiponectin and leptin levels with target organ damage and postoperative clinical outcomes of patients with primary aldosteronism (PA). Methods: 68 PA patients who underwent unilateral adrenalectomy and had follow-up information for at least 6 months after surgery were included. Serum adiponectin and leptin concentrations were detected at baseline. Postoperative clinical outcomes were evaluated according to primary aldosteronism surgical outcome (PASO) criteria. The correlation of serum adiponectin and leptin levels with target organ damage and postsurgical clinical outcome was analyzed. Results: 28 patients (41.2%) with PA were clinically cured after surgery, and 40 patients (58.8%) were not clinically cured. The levels of baseline adiponectin and estimated glomerular filtration rate (eGFR) in the clinically cured group were higher than those in the clinically uncured group (all P<0.05), while body mass index (BMI), the daily defined dose value of hypertension medications, the proportion of hyperlipidemia and diabetes were lower (all P<0.05). No difference in leptin levels was detected between the two groups. Leptin levels were negatively correlated with the E/A ratio and ankle-brachial pressure index (all P<0.05). Adiponectin levels were not correlated with target organ damage indicators. Multivariate stepwise logistic regression analysis showed that lower BMI (OR=0.422，95% CI 0.272-0.653，P<0.001) and higher adiponectin levels (OR=1.359，95% CI 1.004-1.840，P=0.047) were independently associated with postoperative clinical cure. We further stratified patients based on BMI, and identified that higher eGFR (OR=1.074，95% CI 1.023-1.127，P=0.004) and adiponectin levels (OR=1.816，95% CI 1.261-2.616，P=0.001) were associated with postoperative clinical cure in non-obese patients with PA. Conclusion: Baseline serum adiponectin and leptin detection is helpful to evaluate PA target organ damage, predict postoperative clinical outcomes, and assist in guiding the accurate management of PA.
