骨代谢标志物与原发性醛固酮增多症的相关性研究

A Correlative Study of Bone Metabolism Markers and Primary Aldosteronism

摘要: 目的：本研究通过选取原发性醛固酮增多症(PA)患者与原发性高血压(EH)患者的各项化验指标进行比较，探讨醛固酮过量对骨代谢的影响，分析PA患者各项指标与骨代谢标志物的相关性，为PA继发的骨质疏松精准治疗提供依据，以期改善PA患者的预后及生活质量。方法：回顾性收集2021.01~2025.01就诊于青岛大学附属医院诊断的PA患者255例，EH患者232例，收集患者的年龄、性别、身体质量指数(Body Mass Index, BMI)、最高收缩压、最高舒张压以及骨代谢标志物、性激素指标、肾素–血管紧张素–醛固酮系统(Renin-Angiotensin-Aldosterone System, RAAS)指标、血脂、电解质指标进行统计学对比，为了尽量减少更年期、绝经期的影响，按照年龄分层将PA组与EH组分别分为<60岁组、≥60岁组，进行基线资料对比。选取PA患者RAAS指标与骨代谢标志物、性激素及年龄、性别、BMI进行相关性分析。结果：基线资料对比发现两组患者在年龄、BMI、最高收缩压、性激素相关化验上无显著差异性，PA组患者骨钙素、甲状旁腺激素(parathyroid hormone, PTH)、I型胶原羧基端肽β特殊序列(collagen type I carboxy-terminal telopeptide β-specific sequence, β-CTX)、立位血浆醛固酮(plasma aldosterone concentration, PAC)、ARR显著高于EH组(P < 0.001, P < 0.001, P < 0.001, P < 0.001)，PRA、血钙、血钾、PINP显著低于EH组(P < 0.001, P < 0.001, P < 0.001, P < 0.01)。按照年龄分层后发现<60岁患者中，PA的PAC、ARR、PTH、最高收缩压、骨钙素显著高于EH组(P < 0.001, P < 0.001, P < 0.05, P < 0.01)，血钾、血钙、PRA显著低于EH组(P < 0.01, P < 0.001, P < 0.001)。≥60岁患者中，PA组ARR、PTH、骨钙素显著高于EH组(P < 0.001, P < 0.001, P < 0.01)，血钾、血钙、PRA显著低于EH组(P < 0.001, P < 0.001, P < 0.001)。相关性分析显示PAC与PTH呈显著正相关(r = 0.048, P = 0.035)。结论：PA患者骨代谢标志物显著高于EH患者，且PAC与PTH呈正相关，PA继发的甲状腺功能亢进与其骨丢失相关。PA患者早期诊断治疗、补充维生素D对于预防继发性骨质疏松至关重要。

Abstract: Purpose: This study compared various laboratory parameters between primary aldosteronism (PA) patients and essential hypertension (EH) patients, explored the effects of aldosterone excess on bone metabolism, analyzed the correlations between PA-related indicators and bone metabolism markers, and provided a basis for precision treatment of osteoporosis secondary to PA to improve the prognosis and quality of life of PA patients. Methods: This study retrospectively collected 255 primary aldosteronism (PA) patients and 232 essential hypertension (EH) patients diagnosed at Qingdao University Affiliated Hospital between January 2021 and January 2025. The collected data included age, gender, BMI, maximum systolic blood pressure, maximum diastolic blood pressure, bone metabolism markers, sex hormone indices, RAAS system parameters, blood lipids, and electrolyte parameters for statistical comparison. To minimize menopausal and postmenopausal influences, both PA and EH groups were stratified into <60 years and ≥60 years groups for baseline data comparison. Correlation analysis was performed between PA patients’ RAAS indices and bone metabolism markers, sex hormones, as well as age, gender, and BMI. Results: This study compared baseline data and found no significant differences in age, BMI, maximum systolic blood pressure, or sex hormone-related parameters between the two groups. Osteocalcin, PTH, β-CTX, PAC, and ARR were significantly higher in the PA group compared to the EH group (P < 0.001, P < 0.001, P < 0.001, P < 0.001), while PRA, serum calcium, serum potassium, and PINP were significantly lower (P < 0.001, P < 0.001, P < 0.001, P < 0.01). After age stratification, in the <60 years group, PA patients showed significantly higher PAC, ARR, PTH, maximum systolic blood pressure, and osteocalcin compared to EH patients (P < 0.001, P < 0.001, P < 0.05, P < 0.01), and significantly lower serum potassium, serum calcium, and PRA (P < 0.01, P < 0.001, P < 0.001). In the ≥60 years group, PA patients had significantly higher ARR, PTH, and osteocalcin (P < 0.001, P < 0.001, P < 0.01), and significantly lower serum potassium, serum calcium, and PRA (P < 0.001, P < 0.001, P < 0.001). Correlation analysis revealed a positive correlation between PAC and PTH (r = 0.048, P = 0.035). Conclusion: The study found that bone metabolism markers were significantly higher in PA patients compared to EH patients, and PAC was positively correlated with PTH. Hyperthyroidism secondary to PA is associated with bone loss. Early diagnosis and treatment of patients with PA and vitamin D supplementation are essential for the prevention of secondary osteoporosis.