血浆醛固酮/肾素浓度比值在筛查原发性醛固酮增多症患者中的诊断价值

The optimal cutoff of plasma aldosterone to renin ratio in screening patients with primary aldosteronism

目的探讨陕西省血浆醛固酮/肾素浓度比值(aldosterone to renin ratio,ARR)在筛查原发性醛固酮增多症(简称原醛症,primary aldosteronism,PA)患者中的诊断价值,为临床诊断PA提供参考。方法通过联众浏览系统收集西安交通大学第一附属医院在2015年5月1日至2019年8月31日期间经临床资料、肾上腺静脉采血或术后病理确诊的PA患者90例及性别、年龄相匹配的原发性高血压(essential hypertension,EH)患者102例,对一般资料、卧立位醛固酮浓度、卧立位肾素浓度、卧立位ARR进行对比分析,运用受试者工作特征曲线(receiver operating characteristic curve,简称ROC曲线)得出卧立位ARR、醛固酮浓度最佳诊断切点。结果PA组和EH组在性别、年龄、体质指数、高血压病程、高血压水平、用药情况无统计学差异(P>0.05)。PA组的卧立位ARR及醛固酮浓度均高于EH组(P值均<0.001),卧立位肾素活性、血钾水平均低于EH组(P<0.001)。诊断PA患者的ARR最佳切点分别为卧位48.57(pg/mL)/(pg/mL)(敏感度=0.656,特异度=0.961)、立位35.54(pg/mL)/(pg/mL)(敏感度=0.656,特异度=0.922);醛固酮浓度最佳切点分别为卧位174.44 pg/mL(敏感度=0.711,特异度=0.814)、立位232.10 pg/mL(敏感度=0.522,特异度=0.814)。结论卧立位ARR最佳诊断切点的特异度均较卧立位醛固酮浓度特异度高,卧位ARR最佳诊断切点敏感度相近但特异度较立位ARR高,建议立位ARR作为门诊筛查PA患者的首选指标,且住院期间结合卧位ARR和醛固酮浓度可提高诊断的准确率。

Objective To explore the optimal cutoff of plasma aldosterone to renin ratio(ARR)in screening patients with primary aldosteronism(PA)in Shaanxi Province so as to provide reference for clinical diagnosis of PA.Methods A total of 84 PA patients confirmed with clinical data,adrenal venous sampling or surgical pathology and 102 EH patients matched for gender and age were recruited from The First Affiliated Hospital of Xi'an Jiaotong University through the Lianzhong Browsing System from May 2015 to August 2019.We analyzed the patients'general clinical characteristics and biochemical indicators such as ARR,renin and aldosterone concentration in the supine and upright position.We compared the diagnostic performances of different cutoff of ARR and aldosterone in the supine and upright position by receiver operating characteristic(ROC)curves.Results There were no significant differences in gender,age,body mass index,duration of hypertension,or medication history between PA and EH groups(P>0.05).The ARR and aldosterone concentration in the supine and upright position were higher in PA group than in EH group(P<0.001).In contrast,the rennin concentration in the supine and upright position and serum potassium level were lower than those in EH group(P<001).The optimal cutoff of ARR in the supine posture was 48.57(pg·mL-1)/(pg·mL-1)(sensitivity=0.656,specificity=0.961)and that in the upright position was 35.54(pg·mL-1)/(pg·mL-1)(sensitivity=0.656,specificity=0.922).The optimal cutoff of aldosterone concentration in the supine position was 174.44 pg/mL(sensitivity=0.711,specificity=0.814)and that in the upright position was 232.10 pg/mL(sensitivity=0.522,specificity=0.814).Conclusion The specificity of the optimal cutoff of ARR in the supine and upright position was higher than that of aldosterone concentration in the same position.The sensitivity of the optimal cutoff of ARR in the supine position was similar to that in the upright position,but with higher specificity.It was recommended that ARR in the upright position should be the preferred indicator for outpatient screening PA.Moreover,ARR in the upright position combined with ARR and serum aldosterone in the supine position during hospitalization can improve the accuracy of diagnosis.