原発性アルドステロン症患者における心血管・腎臓・代謝症候群ステージ4発生の関連因子分析

To explore the related factors of patients with primary aldosteronism (PA) developing into stage 4 of cardiovascular-renal-metabolic syndrome (CKM). A total of 397 patients diagnosed with PA from January 2016 to December 2024 were retrospectively enrolled. According to the CKM staging criteria, the patients were divided into the early stage group (stages 0-2), stage 3 group and stage 4 group. To analyze the differences in each indicator among the three groups. Multivariate logistic regression models were applied to analyze the correlation between each indicator and the occurrence of CKM stage 4 via stepwise adjustment for confounding factors. Subgroup analyses were further conducted by gender, age (≤50 years and >50 years) and PA subtypes [idiopathic hyperaldosteronism (IHA) and aldosterone-producing adenoma]. Among the 397 PA patients, 231 were males and 166 were females, with a confirmed diagnosis age of (51.1±10.9) years. There were 179 patients in the early CKM stage group (including 1 case in stage 0, 7 cases in stage 1, and 171 cases in stage 2), 107 patients in the CKM stage 3 group, and 111 patients in the CKM stage 4 group. There were statistically significant differences among the 3 groups in age, gender, PA subtype, body mass index, diastolic blood pressure, systolic blood pressure, hypertension duration, proportion of dyslipidemia, proportion of diabetes, proportion of atherosclerosis, proportion of chronic kidney disease, proportion of cerebral infarction, and proportion of coronary heart disease (all <0.05). In terms of laboratory indicators, there were statistically significant differences among the 3 groups in fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, γ-glutamyl transferase, blood potassium, serum creatinine, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), supine aldosterone, and aldosterone 2 hours after the captopril test (all <0.05). Multivariate logistic regression showed that after adjusting for a series of influencing factors including gender, age, BMI, metabolic indicators, disease history and medication history, 2 h post-captopril aldosterone remained independently and positively correlated with the occurrence of CKM stage 4 in PA patients (=1.003, 95%: 1.001-1.005). Subgroup analyses revealed that the correlation between 2-hour post-captopril aldosterone and CKM stage 4 was more significant in the male subgroup (=1.005, 95%: 1.002-1.008),the subgroup aged ≤50 years (=1.006, 95%: 1.002-1.010) andthe IHA subgroup (=1.005, 95%: 1.002-1.008). High aldosterone level is a factor associated with progression of CKM to the clinical event phase (CKM stage 4). Among aldosterone-related indicators, 2 h post-captopril aldosterone has the most stable predictive value, and this correlation presents heterogeneity across populations with different genders, ages and PA subtypes.