评价卧立位醛固酮与肾素比值诊断原发性醛固酮增多症的价值

Value of renin and aldosterone of upright and supine positions in diagnosis of primary aldosteronism in hypertension patients

目的探讨高血压患者卧立位检测血浆醛固酮浓度(plasma aldosterone concentration,PAC)与血浆肾素浓度(plasmareninconcentration,PRC)比值(ratioofaldosterone/rennin,ARR)对原发性醛固酮增多症(primary aldosteronism,PA)的诊断价值与临床应用。方法回顾性分析2018~2019年240例高血压卧立位试验阳性或可疑阳性患者,通过卡托普利试验阳性联合盐水负荷试验阳性确诊114例PA患者及126例原发性高血压(essential hypertension,EH)患者。采用化学发光法检测卧立位PAC及PRC,基于受试者工作特征曲线分析诊断PA卧立位PAC、ARR截断点,评价不同指标诊断PA的敏感性及特异性。结果 PA组与EH组间年龄、性别等基线资料差异无统计学意义,以卡托普利试验联合盐水负荷试验同时阳性为诊断标准,卧位ARR诊断PA最佳截断点6.73,敏感度=79.8%,特异度=90.5%,ROC曲线下面积为0.916(95%CI:0.873,0.948);卧位PAC诊断PA的截断点18.15,敏感度83.3%,特异度64.3%,ROC曲线下面积为0.777 (95%CI:0.719,0.828);立位ARR诊断PA的截断点4.08,敏感度58.8%,特异度87.3%,ROC曲线下面积为0.798 (95%CI:0.742,0.847);立位PAC诊断PA截断点24.39,敏感度69.3%,特异度74.6%,ROC曲线下面积为0.744 (95%CI:0.687,0.801)。结论卧立位ARR较卧立位PAC诊断PA的特异度强而敏感度差,综合两种体位下的激素检查结果可提高诊断PA的准确性。

AIM To determine the cut-off value of plasma aldosterone concentration(PAC) and plasma renin concentration(PRC) of upright and supine positions for primary aldosteronism(PA) screening to improve the diagnostic accuracy of PA.METHODS We retrospectively analyzed 240 suspected PA patients by confirmed diagnosis of primary hypertension(PH) in our hospital from 2018 to 2019.All patients received in-hospital captopril test and intravenous saline load test as confirmed diagnosis test for PA.The area under the curve of receiver operating characteristic(AUCROC) was applied to evaluate PAC and the ratio of aldosterone/renin(RAA) to obtain the best cut-off point with the corresponding sensitivity and specificity for PA diagnosis.RESULTS AUCROC for supine and upright ARR were0.916 and 0.798 respectively.The cut-off point of supine ARR was 6.73(ng/dl)/(ng/L),the diagnostic sensitivity was 79.82% and the specificity was 90.48%.The cut-off point of upright ARR was4.08(ng/dl)/(ng/L),the diagnostic sensitivity was 58.77% and the specificity was 87.30%.AUCROC for supine and upright PAC were 0.777 and 0.744 respectively.The cut-off point of supine PAC was 18.15(ng/dl),the diagnostic sensitivity was 83.33% and the specificity was 64.29%.The cut-off point of upright PAC was 24.39(ng/dl),the diagnostic sensitivity was 69.30% and the specificity was 74.60%.CONCLUSION Both upright and supine PAC and RAA are valuable for PA diagnosis.The upright and supine ARR have higher specificity but lower sensitivity than PAC.