生理盐水试验确诊原发性醛固酮增多症临床价值再评价

Revaluation of the clinical value of saline infusion test in diagnosis of primary aldosteronism

目的评价生理盐水试验确诊原发性醛固酮增多症的诊断价值。方法收集上海交通大学医学院附属瑞金医院内分泌科2006—2010年590例怀疑原发性醛固酮增多症患者的病例,其中有357例确诊为原发性醛固酮增多症,233例确诊为原发性高血压。回顾分析这些患者输注生理盐水后血醛固酮变化,绘制ROC曲线以找到合适的切点用来诊断原发性醛固酮增多症。结果输注生理盐水后血醛固酮ROC曲线下面积为0.975(0.959～0.986),曲线与参照曲线下面积0.5比较,差异有统计学意义(P<0.01)。生理盐水试验后血醛固酮大于277 pmol/L(100ng/L)时,诊断原醛症的敏感度及特异度分别为93%及97.8%。结论生理盐水抑制试验可作为原发性醛固酮增多症的确诊试验。

Objective To evaluate the diagnostic value of saline infusion test in diagnosis of primary aldosteronism （PA）. Methods Between 2006 and 2010,590 cases with suspected PA registered in Department of Secretion, Ruijin Hospital were collected. Notably,357 cases were confirmed with PA and 233 cases with primary hypertension. The altered blood aldosterone was retrospectively analyzed after infusion of saline. Moreover, ROC curve was used for the suitable tangent point in order to diagnose PA. Results The area under the curve （ AUC ） of blood aldosterone was 0. 975 after saline infusion （0. 959 -0. 986）. Difference was found between AUC and the area under the referential curve （0. 5） （P 〈0. 01 ）. After infusion of saline, the sensitivity and specificity of PA diagnosis were 93% and 97. 8% under circumstance of blood aldosteronc 〉 100 ng/L,respectively. Conclusion The saline infusion inhibition test might be used as the confirmatory test for diagnosis of PA.