Ying Jing, Kangla Liao, Ruolin Li, Shumin Yang, Ying Song, Wenwen He, Kanran Wang, Jun Yang, Qifu Li, Jinbo Hu
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引用次数: 8
摘要
目的:比较手术或药物治疗对原发性醛固酮增多症(PA)患者心血管疾病(CVD)风险和全因死亡率的影响。方法:检索PUBMED、MEDLINE和Cochrane图书馆进行meta分析。我们纳入了遵循指南支持方案诊断为PA并接受手术或矿皮质激素受体拮抗剂(MRA)药物治疗的患者，以及年龄性别匹配的治疗过的原发性高血压(EH)患者。主要终点是心血管疾病发病率和全因死亡率。结果:与EH相比，经治疗的PA患者发生CVD的风险更高[优势比(OR) 1.79;95%置信区间(CI) 1.39-2.31]。这种升高的风险仅在接受药物治疗的PA患者中观察到[OR 2.11;95%CI 1.88-2.38]，但手术治疗的PA患者无此症状。经治疗的PA患者全因死亡风险显著降低[OR 0.86;95% CI 0.77-0.95]。仅在手术治疗的PA患者中观察到风险降低[OR 0.47;95% CI 0.34-0.66]，但在接受药物治疗的PA患者中没有。结论:与EH患者相比，经药物治疗的PA患者发生心血管疾病的风险更高。前列腺癌的手术治疗降低了心血管疾病和全因死亡率的风险。
Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: A Meta-analysis.
Objectives: To compare the effect of surgical or medical treatment on the risk of cardiovascular diseases (CVD) and all-cause mortality in patients with established primary aldosteronism (PA).
Methods: We searched PUBMED, MEDLINE and Cochrane Library for the meta-analysis. We included patients who were diagnosed with PA following guideline-supported protocols and received surgery or mineralocorticoid receptor antagonist (MRA)-based medical treatment, and age-sex matched patients with treated essential hypertension (EH). Primary endpoints were CVD incidence and all-cause mortality.
Results: Compared with EH, patients with treated PA had a higher risk of CVD [odds ratio (OR) 1.79; 95% confidence interval (CI) 1.39-2.31]. This elevated risk was only observed in patients with medically treated PA [OR 2.11; 95%CI 1.88-2.38] but not in those with surgically treated PA. The risk of all-cause mortality was significantly lower in patients with treated PA [OR 0.86; 95% CI 0.77-0.95] compared to EH. The reduced risk was only observed in patients with surgically treated PA [OR 0.47; 95% CI 0.34-0.66], but not in those with medically treated PA.
Conclusions: Patients with medically treated PA have a higher risk of CVD compared to patients with EH. Surgical treatment of PA reduces the risk of CVD and all-cause mortality in patients with PA.
期刊介绍：
JRAAS is a peer-reviewed, open access journal, serving as a resource for biomedical professionals, primarily with an active interest in the renin-angiotensin-aldosterone system in humans and other mammals. It publishes original research and reviews on the normal and abnormal function of this system and its pharmacology and therapeutics, mostly in a cardiovascular context but including research in all areas where this system is present, including the brain, lungs and gastro-intestinal tract.
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