不同体位血浆肾素和醛固酮及其比值诊断原发性醛固酮增多症的价值

Value of plasma renin,aldosterone and aldosterone to renin ratio in different positions to diagnosing primary aldosteronism

目的探讨立、坐、卧位血浆肾素、醛固酮及醛固酮/肾素比值(aldosterone to renin ratio,ARR)对原发性醛固酮增多症(primary aldosteronism,PA)的诊断价值。方法采用放射免疫法检测108例高血压患者立、坐、卧位血浆肾素活性及醛固酮水平,并行静脉盐水负荷试验;以静脉盐水负荷试验为PA的诊断标准,分别绘制肾素、醛固酮及ARR的ROC曲线。结果卧位醛固酮的AUC最大,卧位ARR的AUC最大,诊断PA的准确性较高;以卧位醛固酮最佳切点53ng/L诊断PA,与盐水负荷试验的符合率为41.1%;以卧位ARR的最佳切点118.3h诊断PA,与盐水负荷试验的符合率为57.1%;卧位醛固酮最佳切点53ng/L联合卧位ARR最佳切点118.3h诊断PA的敏感度为47.6%,特异度为94.1%,约登指数为0.471,与盐水符合试验的符合率为85.7%。结论对不宜行静脉盐水负荷试验的人群,以卧位ARR≥118.3h联合卧位醛固酮≥53ng/L为标准诊断PA可提高其诊断率。

Objective To discuss the values of plasma renin activity, plasma aldosterone concentration and aldosterone to renin ratio （ARR） in three positions （upright, sitting and supine positions） to diagnosing primary aldosteronism. Methods A total of 108 patients were detected plasma renin activity and plasma aldosterone concentration in three positions by using radioimmunity assay, and received intravenous saline load test. The ROC curves of plasma renin activity, plasma aldosterone concentration and ARR were drawn respectively on the basis of the intravenous saline load test results as diagnostic standard for primary aldosteronism. Results The AUC values of plasma aldosterone concentration and ARR in supine position were the biggest, indicating a high diagnostic accuracy for primary aldosteronism. The optimum cut-off points of ARR and plasma aldosterone concentration in supine position were 118.3 hours and 53 ng/L, with the coincidences of 57. 1% and 41. 1% with intravenous saline load test to diagnose primary aldosteronism. The sensitivity, specificity and Youden index of the combination of ARR ≥118. 3 hours with plasma aldosterone concentration ≥53 ng/L in supine position were 47. 6%, 94. 1% and 0. 471, with the coincident rate of 85.7%. Conclusioll In the patients unable to undergo intravenous saline load test, ARR （≥118.3 hours） combined with plasma aldosterone concentration （≥ 53 ng/L） in supine position could improve the diagnosis rate of primary aldosteronism.