原发性醛固酮增多症术后发热的危险因素

Risk factors of postoperative fever in primary aldosteronism patients

摘要

目的 分析原发性醛固酮增多症（PA）患者术后发热的发生率以及引起发热的危险因素。方法 回顾性分析北京大学人民医院2018年1月-2021年7月收治的116例PA患者的资料，根据术后体温将患者分为发热组（体温≥38.0 ℃，41例）和未发热组（体温＜38.0 ℃，75例），比较两组患者术前和术后临床及随访资料，并分析术后发热的危险因素。同时进一步将发热组分为低热组（体温≥38.0 ℃且＜38.5 ℃，19例）和高热组（体温≥38.5℃，22例），比较亚组间的临床资料。结果 本组患者术后发热的发生率为35.3%。多因素logistic回归分析提示更低的病史最低血钾（OR=0.419，95%CI:0.196～0.894，P=0.025）、更低的高密度脂蛋白胆固醇（HDL-C）（OR=0.112，95%CI:0.018～0.687，P=0.018）和术后肾上腺皮质功能不全（OR=4.158，95%CI:1.731～9.989，P=0.001）可能是PA患者术后发热的独立危险因素。高热组与低热组各因素比较差异并无统计学意义。术后仅1例患者有明确感染证据。术后肾上腺皮质功能不全者40例（34.5%），但随访提示无需接受长期糖皮质激素替代治疗。结论 PA患者术后发热率较高，术后短期肾上腺皮质功能不全是发热的可能原因，应及时补充适量的糖皮质激素。此外，建议对所有接受手术的PA患者常规进行肾上腺皮质功能的评估。

Abstract

Objective To explore the risk factors of postoperative fever in primary aldosteronism (PA) patients. Methods Clinical data of 116 PA patients undergoing adrenalectomy in Peking University People's Hospital during Jan. 2018 and Jul. 2021 were retrospectively analyzed. Based on postoperative body temperature, the patients were divided into fever group (body temperature ≥38.0 ℃, n=41) and non-fever group (body temperature <38.0 ℃, n=75). Clinical features were analyzed between the two groups. The fever group was subdivided into low fever group (38.0 ℃≤body temperature <38.5 ℃, n=19) and high fever group (body temperature ≥38.5 ℃, n=22). The clinical data of the subgroups were compared. Results The incidence of postoperative fever was 35.3%. Logistic regression analysis showed that lower lowest potassium on records (OR=0.419, 95%CI: 0.196-0.894, P=0.025), lower high-density lipoprotein cholesterol (HDL-C) (OR=0.112, 95%CI: 0.018-0.687, P=0.018), and postoperative adrenal insufficiency (OR=4.158, 95%CI: 1.731-9.989, P=0.001) were independent risk factors for postoperative fever. There was no difference between the high and low fever groups. After surgery, infection occurred in 1 patient, adrenal insufficiency in 40 (34.5%) patients, but long-term follow-up indicated that no patients needed lifelong glucocorticoid replacement. Conclusion Fever is a common postoperative complication in PA patients, most likely due to transient adrenal insufficiency. Glucocorticoid supplementation should be administered appropriately and timely based on laboratory tests and clinical manifestations. Evaluation of adrenal function is highly recommended for patients undergoing adrenalectomy.

关键词

原发性醛固酮增多症 / 肾上腺切除术 / 发热 / 肾上腺功能不全

Key words

primary aldosteronism / adrenalectomy / fever / adrenal insufficiency

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