原发性醛固酮增多症筛查试验面临的挑战

Challenges in screening tests of primary aldosteronism

原发性醛固酮增多症(原醛)是最常见的内分泌高血压的病因,甚至是最常见的继发性高血压的病因。原醛的临床表现隐匿,但是却有较高的心脑血管死亡率。原醛的发病率超过5%,在高血压人群中超过10%,在难治性高血压人群中甚至达20%。所有高血压患者都应进行原醛的筛查。肾素-醛固酮比值(ARR)是最有效的筛查原醛的方法。不同检测方法对ARR比值影响很大。进一步确诊试验包括:口服钠负荷试验,氟氢可的松试验,生理盐水抑制试验和卡托普利试验。不同地区应根据自己实验室所采用的检测方法建议一个适合自己人群的原醛诊断切点。

Primary aldosteronism （PA） is recognized as the most frequent cause of endocrine hypertension, and also the most frequent cause of secondary hypertension. PA is often unrecognized and is associated with a high rate of cardiovascular and cerebrovascular complications. PA prevalence rate is more than 5%, affecting over10% of the general hypertensive population and even20 96 of refractorypopulation.;AU hypertension patients should be carefully screened for PA. Screening with aldosterone-to-renin ratio （ARR） is advocated as the most reliable tool to screen for PA. The different analytical methods have a great influence on the ARR ratio. Subsequent confirmatory tests are： oral salt loading, fludrocortisone suppression test, saline infusion test and captopril challenge test. Individual laboratories should select an cut-offvalue （for their combination of renin and aldosterone methods） that is based on validation in their local population.