尿钾与血钾浓度平方比值筛查高血压伴原发性醛固酮增多症的作用研究

The effectiveness on screening for primary aldosteronism in patients with hypertension by using the urinary potassium to （ serum potassium） ^2 ratio

目的评价尿钾与血钾、尿钾与血钾平方的比值在高血压患者中筛查原发性醛固酮增多症(PA)的可行性。方法收集1997—2007年卫生部北京医院收治的55例PA以及年龄和体重指数相匹配的50例原发性高血压患者的临床资料,计算出两组尿钾/血钾(UPP)和尿钾/血钾平方(UPPP),并与醛固酮/肾素(ARR)进行比较分析。结果 (1)PA组的UPP和UPPP及ARR均高于原发性高血压组(P<0.05)。(2)相关分析显示,UPP和UPPP与ARR明显相关(P<0.05)。(3)根据ROC曲线下面积,UPP和UPPP均有筛查PA的意义,但UPPP的预测更接近于ARR。其中,ARR和UPPP在切点分别为18.9和3.2时预测PA的灵敏度和特异度分别为90.9%、98.0%和80.0%、81.4%。结论尿钾/血钾平方的比值与目前公认的筛查工具——ARR有很好的相关性,同时又有较高的预测灵敏度和特异度,且具有简便、快速、花费少的特点,因此临床上可用于在高血压人群中初步筛查PA。

Objective To assess the effectiveness of the urinary potassium to serum potassium ratio and urinary potassium to （ serum potassium ） 2 ratio in the screening for primary aldosteronism （ PA ） from the patients with hypertension. Methods We analyzed all the 55 patients with PA, 50 patients with essential hypertension （EH） matched with age and body mass index（BMI）. We compared the urinary potassium to serum potassium ratio（UPP） and urinary potassium to （serum potassium）2 ratio（UPPP） with the serum aldosterone-to-renin ratio （ARR） between PA and EH groups. Results （ 1 ） UPP, UPPP and ARR in PA group were higher than in EH group （ P 〈 0. 05 ） ; （ 2 ） UPP and UPPP had good correlation with the ARR （ P 〈 0.05 ） ; （ 3 ） According to the area under curve （AUC） of ROC curves, both UPP and UPPP had significance in screening for PA, and of which, the prediction of UPPP was more close to ARR. ARR distinguished PA from EH with a sensitivity of 90. 9% and a specificity of 98.0% at a cutoff of 18. 9 and the sensitivity and specificity of UPPP was 80. 0% and 81.4% at a cutoff of 3.2. Conclusion UPPP is known as a screening instruments at present. With a good correlation with ARR, higher predicted sensitivity and specificity, and convenient, fast and cheap characters, UPPP would be acceptable for a clinical application as a rapid tool on the screening for PA from the patients with hypertension.