立位血浆醛固酮浓度与血浆肾素浓度的比值对原发性醛固酮增多症的诊断价值

DIAGNOSTIC VALUE OF THE RATIO OF ORTHOSTATIC PIASMA ALDOSTERONE CONCENTRATION TO PLASMA RENIN CONCENTRATION IN PRIMARY ALDOSTERONISM

目的:探讨立位血浆醛固酮浓度/血浆肾素浓度比值(ADRR)筛查原发性醛固酮增多症(原醛)的最佳诊断界值。方法:80例高血压原因待查患者根据是否合并原醛分为原醛组(合并原醛,n=20)和原发性高血压组(高血压组,未合并原醛,n=60)。检测所有患者的身高、体重、血压、血钾等指标,以及检测立位血浆醛固酮浓度(PAC)、血浆肾素活性(PRA)、血浆直接肾素浓度(PDC),并计算PAC与PRA的比值(ARR)和ADRR。绘制受试者工作特征曲线(ROC)以确定ADRR筛查原醛的最佳诊断界值。结果:原醛组患者血钾水平、PDC、PRA显著低于高血压组,PAC、ADRR、ARR显著高于高血压组(P<0.05)。ARR的ROC曲线下面积为0.698,筛查原醛的诊断界值为63.77[(pg/ml)/(μg/L/h)];ADRR的ROC曲线下面积为0.882,筛查原醛的诊断界值为2.55(pg/ml)/(pg/ml)。结论:ADRR筛查原醛的诊断价值高于ARR,建议临床可将ADRR用于原醛的筛查。

Objective:To explore the best cut-off point of orthostatic plasma aldosterone/plasma renin concentration(ADRR)for screening primary aldosteronism(PA).Methods:80 cases of patients with unknown causes of hypertension were divided into PA group(combined with PA,n=20)and primary hypertension group(hypertension group,not combined with PA,n=60).The body height,body weight,blood pressure,blood potassium,orthostatic plasma aldosterone concentration(PAC),plasma renin activity(PRA)and plasma direct renin concentration(PDC)were measured respectively of all the patients;And the PAC/PRA(ARR)and ADRR were calculated.The ROC curve was drawn to determine the best cut-off point of orthostatic ADRR screening for PA.Results:The serum potassium level,PDC and PRA of patients in PA group were significantly lower than hypertension group,while the PAC,ADRR and ARR were significantly higher than hypertension group(P<0.05).The area under ROC curve of ARR was 0.698,and the diagnostic cut-off for screening PA was 63.77[(pg/ml)/(μg/L/h)].The area under ROC curve of ADRR was 0.882,and the diagnostic cut-off for screening PA was 2.55(pg/ml)/(pg/ml).Conclusions:The diagnostic value of ADRR screening for PA is higher than that of ARR.It is suggested that ADRR can be used in clinical screening for PA.