Objective:To investigate the incidence and influencing factors of aldosterone escape in patients with primary aldosteronism(PA)after spironolactone treatment.Methods:The data of 144 patients with PA admitted to Fuwai Cardiovascular Disease Hospital in Yunnan Province from January 2021 to March 2023 were retrospec-tively analyzed.According to the changes of aldosterone concentration before and after spironolactone treatment,they were categorized into non-escape group and escape group.The clinical data of the two groups were compared before the administration of spironolactone,and the influencing factors were analyzed at the same time.Results:Aldosterone escape occurred in 68 of 144 patients with PA,and the incidence of aldosterone escape was 47.22％.Compared with the non-escape group,the escape group had a lower proportion of pre-dose renal insufficiency,and lower plasma aldosterone(standing),aldosterone(lying),urea nitrogen(BUN),homocysteine(HCY),C-reactive protein(CRP),triiodothyronine(T3),thyroxine(T4),free triiodothyronine(FT3)levels,and urinary microalbu-min/creatinine,and the differences were statistically significant(all P＜0.05).One-way logistic regression analy-sis showed that history of renal insufficiency,plasma aldosterone(standing),aldosterone(lying),T3,FT3,and thyroid-stimulating hormone(TSH)levels prior to medication were correlated with the occurrence of post-treat-ment aldosterone escape in patients with PA(β=-0.985,OR=0.373,P=0.031;β=-0.063,OR=0.938,P=0.002;β=-0.060,OR=0.942,P=0.014;β=-1.103,OR=0.332,P=0.029;β=-0.631,OR=0.532,P=0.010;β=-0.249,OR=0.780,P=0.044).Multifactorial logistic regression analysis showed that pre-dose plasma aldosterone(standing),FT3,and TSH levels were independent risk factors for the occurrence of aldosterone escape after treatment in PA patients(β=-0.053,OR=0.949,P=0.031;β=-0.910,OR=0.402,P=0.042;β=-0.379,OR=0.685,P=0.013).Conclusion:Some patients with PA experienced aldo-sterone escape after spironolactone treatment,and pre-dose plasma aldosterone(standing),FT3,and TSH levels were independent risk factors for this phenomenon.
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