原发性醛固酮增多症李江源ppt课件.pptVIP

原发性醛固酮增多症（Primary Aldosteronism）;原发性醛固酮增多症的发现;原发性醛固酮增多症;醛固酮分泌的调节因子;Prorenin ↓ Renin ↓ Angiotensinogen ATI ATII (1q 42.3, 485AA) (10肽，-His-Leu)(Asp.Arg.Val.Tyr.Ile.His.pro.phe);;●;肾K排泄;▲;;;K的作用机理;Figure 4. Stimulation by angiotensin II, ET-1 and ET-3 of aldoste-rone secretion by calf zona glomerulosa cells in culture. A representative experiment is shown (n=3). Each point is the mean±SEM of four wells. The increase of aldosterone secretion was significant (P0.05) with all doses.;Aldosterone-Stimulating Factor (ASF);;;;;;;;;;;嗜铬细胞瘤的定位诊断（俄）;儿茶酚胺的代谢效应;与pheo有关的疾病;低肾素高醛固酮的常见原因;原发性醛固酮增多症的临床表现;原发性醛固酮增多症的诊断;高血压低血钾;Liddle综合征;盐水输注试验（Saline Infusion Test）;Subtypes of Primary Hyperaldosleronism;;体位试验（Posture Test）;20 10 8 6 4 2 1 0.5 0.1;;各型原醛醛固酮水平(mg/dl)对体位和Spl试验的反应;安体舒通试验（Spironolactone Test）;50 40 30 20 10 0;血清18-OHB水平测定;Figure 10. Plasma 18 OHB levels (ng/dl) in 34 patients with primary aldosteronism, nine patientswith essential hypertension (SHBP), and ten normal subjects (NL). From Kem et al. 69;GSHA诊断试验;;;GSHA的分子病因（同源基因重组错误）;不同类型原醛的生化改变;根据Aldo的反应鉴别各型原醛;肾上腺CT扫描;Scintigraphy in primary Aldosteronism;碘胆固醇肾上腺闪烁扫描;肾上腺静脉采血;原醛的治疗;APA的治疗;1例原醛患者肾上腺静脉插管结果;原醛的药物治疗（一）;;Amiloride(20-40mg/日）和SPL（200-400mg/日×6W）治疗原醛的比较;;氨苯喋啶（50mg）+双克（25mg）治疗原醛;心痛定（30-50mg/日）治疗原醛（6例）4周的疗效;原醛的药物治疗（二）;Trilostane（睛环氧雄烷）;(n=9) (n=9);;;;赛庚啶*治疗APA和IHA;;+20 +10 0;;Nact 0.9%;;