2021年 · 第101卷第34期

Primary hyperaldosteronism (PA) is due to the increase in aldosterone caused by aldosterone-secreting adenoma (APA) or bilateral adrenal hyperplasia (IHA), which leads to hypertension and hypokalemia. PA-related hypertension can cause serious damage to cardiovascular, kidney and other target organs. The standard treatment for APA patients is adrenalectomy, with surgical outcomes differentiated into clinical and biochemical outcomes, with clinical cure referring to complete elimination of postoperative hypertension without the need for additional antihypertensive drugs, and biochemical cure referring to normalization of serum potassium, aldosterone, and plasma renin activity levels. Although hypokalemia and hypertension will return to normal in most patients after adrenalectomy, 40% to 70% of patients still need antihypertensive drugs to control their blood pressure. To explore preoperative factors associated with biochemical and clinical outcomes after laparoscopic adrenalectomy in patients with PA, the study retrospectively included 202 patients who underwent adrenalectomy (37 of whom met the diagnosis of PA) for analysis. Patients had a confirmed age of (50 ± 10) years, most were female (59%), had hypertension for 10 (3, 20) years, and had taken at least 2 (1, 3) types of antihypertensive drugs. All 37 patients with PA achieved biochemical cure after adrenalectomy, and 41% achieved complete clinical cure. Types of blood pressure medications taken (OR=2.30，95%CI：1.07~4.93，P<0.05), time to hypertension (OR=1.11，95%CI：1.03~1.25，P<0.05) and BMI (OR=1.13，95%CI：1.01~1.29，P<0.05) was an associated factor for postoperative clinical cure. Age, sex, ethnicity, preoperative aldosterone or renin levels, and tumor volume were not associated factors to predict clinical cure.

Both type 2 diabetes and dementia are the most common diseases in later life. Patients with type 2 diabetes have an increased risk of cognitive impairment, which may lead to difficulties in self-management and increase the risk of diabetes-related complications. It has been reported that low-grade inflammation may lead to cognitive dysfunction, while vitamin D [25-hydroxyvitamin D,25 (OH) D] deficiency is associated with various neuropsychiatric symptoms and also plays an important role in the development of dementia. Recent evidence suggests that low 25 (OH) D levels are associated with elevated levels of inflammatory markers. Previous studies have described the relationship between inflammation [expressed by high-sensitivity C-reactive protein (hs-CRP)] or 25 (OH) D levels and mild cognitive impairment (MCI) in diabetic patients, but in elderly patients with type 2 diabetes with MCI, there is still a lack of data to explore the relationship between mild inflammatory status and serum 25 (OH) D levels and MCI. In order to find factors associated with MCI in elderly patients with type 2 diabetes, including 25 (OH) D and hs-CRP levels, the study included 194 elderly patients with type 2 diabetes who attended the diabetes outpatient clinic of the Hospital affiliated to the Medical University of Lodz, Poland, from November 2013 to February 2014, and were divided into MCI group (62 cases) and control group (132 cases) by cognitive assessment. The MCI group had lower levels of 25 (OH) D and higher levels of hsCRP compared to the control group (bothP<0.01）； 25 (OH) D levels were inversely correlated with hsCRP levels (r=-0.28，P=0.028), positively associated with the Montreal Cognitive Assessment (MoCA) score (r=0.31，P=0.016）； hsCRP levels were inversely correlated with MoCA scores (r=-0.59，P<0.01), positively correlated with glycosylated hemoglobin (HbA1c) levels (r=0.55，P<0.01）。 Multivariate analysis showed that short years of formal education, previous cardiovascular disease and hypertension, increased number of comorbidities, high hsCRP levels, and low 25 (OH) D levels increased the risk of developing MCI in older patients with type 2 diabetes.