血浆醛固酮/肾素浓度比值诊断原发性醛固酮增多症的价值

Role of plasma aldosterone to direct renin ratio in primary aldosteronism

目的探讨血浆醛固酮/肾素浓度比值(ADRR)对原发性醛固酮增多症(PA)的诊断价值及最佳临界值。方法选取高血压患者222例,其中PA临床确诊患者33例(CPA组)。采用化学发光法检测血浆醛固酮及肾素浓度,并计算ADRR。采用受试者工作特征(ROC)曲线评价ADRR对PA的诊断价值,并确定最佳临界值。结果高血压患者中PA患者的比例为14.86%(33/222)。PA组卧位和立位的血浆肾素浓度均明显低于高血压组(P<0.05),ADRR则明显高于高血压组(P<0.05)。ROC曲线分析显示,血浆ADRR诊断PA卧位和立位的曲线下面积(AUC)分别为0.906和0.908;ADRR卧位的最佳临界值为31.32,敏感性和特异性分别为96.97%和73.54%;立位的最佳临界值为27.57,敏感性和特异性分别为81.82%和86.77%。结论血浆ADRR是筛查PA的有效指标。建议在PA初筛时采用25作为立位ADRR筛查的最佳临界值。

Objective To investigate the role of plasma aldosterone to direct renin ratio(ADRR)in the diagnosis of primary aldosteronism(PA)and its optimal cut-off value.Methods A total of 222 hypertension patients were enrolled,and there were 33 cases of PA.Plasma aldosterone and renin were determined by chemiluminescence immunoassay.ADRR was calculated.Using receiver operating characteristic(ROC)curve,the role and cut-off value of ADRR for the diagnosis of PA were evaluated.Results The proportion of PA in hypertension patients was 14.86%(33/222).Plasma renin levels at both supine and upright positions in PA group were lower than those in hypertension group(P<0.05).ADRR in PA group was higher than that in hypertension group(P<0.05).ROC curve analysis showed that the areas under curves(AUC)of ADRR were 0.906(supine position)and 0.908(upright position).The optimal cut-off value of ADRR at supine position was 31.32.The sensitivity was 96.97%,and the specificity was 73.54%.However,the optimal cut-off value of ADRR at upright position was 27.57,the sensitivity was 81.82%,and the specificity was 86.77%.Conclusions Plasma ADRR is an effective index for PA screening,and the cut-off value 25 is optimal for screening ADRR at upright position.