卡托普利肾动态显像诊断肾血管性高血压及血浆肾素的影响

Captopril renal scintigraphy in diagnosis of renovascular hypertension and the impact of plasma renin activity

目的探讨卡托普利肾动态显像(CRS)诊断肾血管性高血压(RVH)的效能及血浆肾素活性(PRA)的影响。方法回顾性分析35例接受立、卧位外周血浆PRA、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)水平检测及基础、CRS的RVH患者,按CRS结果分为阳性组和阴性组。比较2组激素水平,以ROC曲线分析2组血浆立位PRA,得出PRA的最低阈值。结果阳性组24例,阴性组11例。阳性组立位PRA较阴性组升高(Z=3.11,P<0.001);2组卧位PRA、立卧位AngⅡ及ALD差异均无统计学意义(P均>0.05)。ROC曲线分析显示2组立位PRA的AUC为0.84,PRA为2.47 ng/(ml·h)时,CRS诊断RVH阳性的灵敏度为83.33%,特异度为81.82%。结论立位PRA是影响CRS诊断RVH敏感度的重要因素。联合测定血浆PRA可提高CRS对RVH的诊断效能。

Objective To observe the diagnostic efficiency of Captopril renal scintigraphy(CRS)for renovascular hypertension(RVH)and the impact of plasma renin activity(PRA).Methods Plasma levels of PRA,angiotensinⅡ(AngⅡ)and aldosterone(ALD)in peripheral blood in orthostatic position and supine position of 35 RVH patients who underwent basic renal scintigraphy and CRS examination were retrospectively analyzed.According to CRS,the patients were divided into positive group and negative group.The levels of PRA,AngⅡand ALD were analyzed.ROC curve was used to analyze PRA and obtain the minimum threshold.Results There were 24 cases in positive group and 11 cases in negative group.The orthostatic position PRA in positive group was significantly higher than that in negative group(Z=3.11,P<0.001).The supine position PRA,supine and orthostatic position AngⅡand ALD were not statistically different between two groups(all P>0.05).ROC curve analysis showed that the area under the curve was 0.84.When the threshold point of PRA was 2.47 ng/(ml·h),the sensitivity and specificity were 83.33%and 81.82%,respectively.Conclusion Orthostatic position PRA is an important impact factor of diagnostic sensitivity of CRS for RVH.Combining with orthostatic position plasma PRA can improve the value of CRS for diagnosis and treatment of RVH.