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目的 观察特发性醛固酮增多症(IHA)患者服用螺内酯前、后胰岛β细胞功能的变化.方法 选择北京积水潭医院2000年至2014年期间诊治的80例IHA患者为研究对象.按是否服用螺内酯分为螺内酯组(52例)及非螺内酯组(28例),平均随访28个月,比较两组患者在不同治疗前、后稳态模型评估-胰岛素抵抗指数(HOMA-IR)的变化,并分析其相关因素.结果 IHA患者经螺内酯治疗后,血钾由(3.13±0.69) mmol/L升高至(4.25±0.60) mmol/L(P =0.00);醛固酮肾素比值(ARR)由64(16,189)下降至12(7,27,P＜0.01);应用60～ 80 mg螺内酯治疗的患者其β细胞功能优于应用螺内酯20 mg治疗者.治疗后HOMA-IR的变化和立位醛固酮有正相关的趋势(r=0.020,P=0.050).结论 IHA患者的胰岛素抵抗与高醛固酮血症有关,中等剂量的螺内酯治疗对改善胰岛素抵抗有效.

Objective To investigate the changes of islet β cell function in patients with idiopathic hyperaldosteronism(IHA) after taking spironolactone.Methods Eighty patients with IHA from 2000 to 2014 were investigated.They were divided into spironolactone group (52 cases) and non spironolactone group (28 cases) according to whether taking spironolactone or not.After following-up for 28 months,the homeostasis model assessment-insulin resistance index (HOMA-IR) and related factors were compared and analyzed before and after treatment.Results After treated by spironolactone,the potassemia of ⅢA patients was improved from (3.13 ± 0.69) mmol/L to (4.25 ± 0.60) mmol/L (P =0.000),and aldosterone-to-renin ratio was decreased from 64 (16,189) to 12 (7,27) (P ＜ 0.05).Patients treated with 60-80 mg spironolactone had a better β cell function compared with those treated with 20 mg spironolactone.The change of HOMA-IR after treated by spironolactone was positively correlated with orthostatic aldosterone (r =0.020,P=0.050).Conclusion In patients with IHA,insulin resistance is related to hyperaldosteronism,medium dose of spironolactone is efficient in stabilizing insulin resistance.