醛固酮肾素定量比值筛查原发性醛固酮增多症的探讨

Investigating the Effectiveness of the Aldosterone to Active Renin Ratio （AARR） for Screening Primary Aldosteronism

目的 探讨醛固酮肾素定量比值（PAC/PRC以下简称AARR）筛查原发性醛固酮增多症（以下简称为原醛症）的价值.方法 使用化学发光方法检测32例原醛症和88例原发性高血压患者立、卧位醛固酮和肾素浓度,计算醛固酮肾素浓度比值（AARR）,构建AARR对原醛症的ROC曲线,确定AARR筛查原醛症的最佳切点.结果 原醛症患者组立位肾素浓度为4.55 （15.67） pg/ml,卧位为2.85（5.34） pg/ml,立位醛固酮浓度为213.70 （237.38） pg/ml,卧位为207.52（137.90）pg/ml,立位AARR为61.53（182.84）,卧位为100.69（254.03）.原发性高血压患者组立位肾素浓度为6.80（11.90）pg/ml,卧位为4.79（8.36） pg/ml,立位醛固酮浓度为121.20（31.94）pg/ml,卧位为112.47（23.99） pg/ml,立位AARR为17.49（28.57）,卧位为22.67（37.43）.立位AARR筛查原醛症的ROC曲线AUC为0.802,Youden＆#39;s指数提示最佳切点为54.40 pg/ml,灵敏度为0.719,特异度为0.852;卧位AARR筛查原醛症的ROC曲线AUC为0.848,最佳切点为64.18 pg/ml,灵敏度为0.750,特异度为0.818.卡方检验提示立、卧位AARR筛查原醛症的诊断效果差异无统计学意义（P＞0.05）.结论 临床上采用醛固酮肾素定量比值对原发性醛固酮增多症进行筛查有一定的应用价值,且立、卧位AARR诊断效果相当.

：Objective To investigate the effectiveness of the aldosterone to active renin ratio（AARR） for screening primary aldosteronism（PA）. Methods Detected the plasma renin concentration （PRC） and： plasma aldosterone concentration of PA group （32 samples） and primary hypertension group（88 samples）. Used SPSS statistical software to analys the results of the patient and build the ROC of AARR for screening PA. Results The PRC,PAC and AARR of the standing position of PA group was 4.55（15.67）pg/ml,213.70（237.38）pg/ml and 61.53（182.84） ,whose recubent position results was 2.85（5.34） pg/ml,207.52（137.90）pg/ml and 100.69（254.03）at the same time. The PRC,PAC and AARR of the standing position of primary hypertension group was 6.80 （ 11.90） pg/ml, 121.20 （ 31.94 ） pg/ml and 17.49 （ 28.57）, whose recubent position re- sults was 4.79（8.36）pg/ml,112.47（23.99）pg/ml and 22.67（37.43） at the same time. The AUC of the ROC of standing position for screening PA was 0. 802. The sensitivity and specificity was 0. 719 and 0. 852 by using the cutoff value of 54.40. The AUC of the ROC of recumbent position for screening PA was 0. 848. The sensitivity and specificity was 0. 750 and 0. 818 by using the cutoff value of 64.18. There was the same performace between the standing position and recumbent posi- tion for screening PA（P〉0.05）. Conclusion There is some application value to use AARR to screen primary aldosteron- ism. The performace between standing position and recumbent position was the same.