【摘要】：目的 探討腎上腺增生性高血壓患者的臨床及病理特點(diǎn)，評估腎上腺增生性高血壓患者術(shù)后臨床療效及分析影響療效的可能因素。 方法 回顧性分析2012年1月至2012年12月我科收治的腎上腺增生性高血壓的基本資料包括性別、年齡、病程、術(shù)前臨床表現(xiàn)、內(nèi)分泌檢查結(jié)果、影像學(xué)和術(shù)后病理結(jié)果特點(diǎn)，并電話隨訪其術(shù)后臨床癥狀、血壓改善情況及降壓藥服用情況，綜合評估手術(shù)效果，結(jié)合統(tǒng)計(jì)學(xué)方法，分析影響療效的因素，探討診斷及治療方面存在的的問題。 結(jié)果 本組病例75例，，男39例，女36例。年齡20-74歲，平均47歲。術(shù)后病理報告彌漫性增生占56%（42/75例），結(jié)節(jié)性增生占26%（26/75例），皮質(zhì)、髓質(zhì)混合性增生占%（6/75例）。術(shù)后隨訪時間11~21個月，平均隨訪時間15.6個月，分為治愈、改善及無效組。治愈組：停用降壓藥，血壓正�；虬Y狀消失；改善組：降壓藥未減量或已減量或停藥，而血壓較術(shù)前下降，或癥狀好轉(zhuǎn)。無效：降壓藥未減量，血壓較術(shù)前為未下降，或癥狀無緩解。結(jié)果完全有效占31.2%（23/75例），有效果占56.2%（42/75例），無效果占13.3%（10/75例）。對患者術(shù)前及術(shù)后血壓進(jìn)行統(tǒng)計(jì)學(xué)對照，結(jié)果發(fā)現(xiàn)存在顯著差異，有統(tǒng)計(jì)學(xué)意義。經(jīng)統(tǒng)計(jì)分析，患者年齡、病程及術(shù)前血壓對術(shù)后療效的影響存在顯著差異，且差異具有統(tǒng)計(jì)學(xué)意義，是影響術(shù)后療效的因素；而性別、病變側(cè)別、術(shù)后隨訪時間、病理類型及術(shù)前影像學(xué)改變間差異無明顯意義。 結(jié)論 一側(cè)腎上腺切除對大多數(shù)患者可控制血壓及癥狀，手術(shù)治療是一種安全、有效的可能使部分患者受益的治療方法，且術(shù)前及術(shù)后需控制好血壓，術(shù)后應(yīng)繼續(xù)監(jiān)測血壓�；颊吣挲g、高血壓級別、術(shù)前病程可能對患者術(shù)后治療效果存在一定的影響；而患者性別、病變側(cè)別、術(shù)后隨訪時間及病理類型及術(shù)前影像學(xué)變化對術(shù)后療效影響不大。此外，腎上腺增生性高血壓患者臨床表現(xiàn)不特異，臨床表現(xiàn)多樣化，大多數(shù)病人均伴有不同程度的高血壓或頭暈、頭痛，因此對于癥狀性高血壓患者，特別是藥物治療效果欠佳時，應(yīng)考慮到腎上腺是否存在病變，可給與行相關(guān)腎上腺內(nèi)分泌檢查和影像學(xué)檢查�；颊吲R床表現(xiàn)、影像學(xué)檢查及內(nèi)分泌檢查存在不相符合的情況，因此我們應(yīng)綜合上述三方面來做出初步診斷，最終要依靠病理診斷。
[Abstract]:Objective to investigate the clinical and pathological features of patients with adrenal hyperplastic hypertension (ADH), evaluate the clinical efficacy and analyze the possible factors influencing the curative effect. Methods from January 2012 to December 2012, the basic data of adrenal hyperplastic hypertension, including sex, age, course of disease, preoperative clinical manifestation, endocrine examination, imaging and postoperative pathological features, were retrospectively analyzed. The clinical symptoms, the improvement of blood pressure and the use of antihypertensive drugs were followed up by telephone. Combined with statistical methods, the factors affecting the curative effect were analyzed, and the problems existed in the diagnosis and treatment were discussed. Results there were 75 cases, 39 males and 36 females. The age was 20 to 74, with an average of 47. Diffuse hyperplasia (56%), nodular hyperplasia (26%, 75 cases) and mixed hyperplasia of cortex and medulla (6 cases) were found in 56% (42 / 75), 26% (26 / 75) and 6 / 75 (6 / 75) respectively. The follow-up time was 11 to 21 months, the mean follow-up time was 15.6 months, and divided into cure, improvement and ineffective group. In the treatment group, the blood pressure was normal or the symptoms disappeared. In the improvement group, the antihypertensive drugs were not reduced or had been reduced or stopped, but the blood pressure was lower than that before the operation, or the symptoms were improved. Ineffective: the antihypertensive drug did not decrease, blood pressure did not decrease, or symptoms did not relieve. Results the total effective rate was 31.2% (23 / 75), the effective rate was 56.2% (42 / 75) and the ineffective rate was 13.3% (10 / 75). The blood pressure of the patients before and after operation were compared statistically, the results showed that there was significant difference between the two groups (P < 0.05). Statistical analysis showed that the patients' age, course of disease and preoperative blood pressure had significant difference in the postoperative curative effect, and the difference was statistically significant, which was the factor influencing the postoperative curative effect. There was no significant difference in sex, side of lesion, follow-up time, pathological type and preoperative imaging changes. Conclusion unilateral adrenalectomy can control blood pressure and symptoms in most patients. Surgical treatment is a safe and effective treatment that may benefit some patients, and blood pressure should be controlled well before and after operation. Blood pressure should continue to be monitored after operation. The age, the grade of hypertension and the course of disease before operation may have some influence on the curative effect of the patients, but the gender, the side of the lesion, the follow-up time, the pathological type and the preoperative imaging changes have little effect on the postoperative curative effect. In addition, the clinical manifestations of adrenal hyperplastic hypertension patients are not specific, clinical manifestations are diverse, most patients are accompanied by varying degrees of hypertension or dizziness, headache, so for symptomatic hypertension patients, Especially when the effect of drug therapy is poor, we should take into account whether there is any pathological changes in adrenal gland, and can give related adrenal endocrine examination and imaging examination. The clinical manifestation, imaging examination and endocrine examination of the patients do not accord with each other. Therefore, we should combine the above three aspects to make a preliminary diagnosis, and ultimately rely on pathological diagnosis.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R699.3

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