现有特发性醛固酮增多症预测模型在中国人群中应用价值的评估

The predicting value of existing models for idiopathic hyperaldosteronism in Chinese population

目的 评估现有特发性醛固酮增多症(IHA)预测模型在中国人群中的应用价值。方法 纳入2013—2022年于重庆医科大学附属第一医院明确诊断的原发性醛固酮增多症(PA)患者387例,以肾上腺静脉取血及术后随访结果进行分型,其中单侧PA患者275例,IHA患者112例,应用受试者工作特征(ROC)曲线及特异度和灵敏度分析评估已报道的7个预测模型对中国IHA患者的诊断价值。结果 7个IHA预测模型中,Kobayashi2018评分模型、Xiao模型诊断效能最高,ROC曲线的曲线下面积(AUC)分别为0.88和0.92。其他5个模型的AUC介于0.51~0.80。进一步验证模型的推荐切点,Kobayashi2018评分(≥8分)和Umakashi模型(血钾正常+CT示双侧肾上腺无异常)在满足高特异度(≥95%)的情况下,灵敏度较高,分别为38%、36%。结论 考虑到简便性、可行性、推广性、准确性等因素,推荐在中国PA患者中使用Kobayashi2018年评分或Umakoshi模型来筛查IHA患者。

Objective To evaluate the predicting value of existing models for idiopathic hyperaldosteronism(IHA) in Chinese population.Methods In this cross-sectional study,387 patient with primary aldosteronism(PA) in the First Affiliated Hospital of Chongqing Medical University from January 2013 to March 2022 were evaluated.Briefly,275 patients with unilateral PA and 112 with IHA were included.Patients with PA were subtyped according to adrenal venous sampling or postoperative remission situation.Based on the subtype,the diagnostic value of 7 IHA prediction models was evaluated using receiver operating characteristic(ROC) curveand sensitivity and specificity analysis.Results Among the 7 IHA prediction models,Kobayashi2018 score and Xiao model were verified to have high diagnostic efficiency,with the area under the ROC curve(AUC) of 0.88 and 0.92,respectively.The AUC of the other five models ranged from 0.51 to 0.80.The recommended cutoffs of the model were further verified.Kobayashi2018 score(≥8 points) and Umakashi model(normal serum K~+ with negative adrenal CT) were found to have relatively high sensitivity(38% and 36%,respectively)when high specificity(≥95%) was achieved.Conclusion Considering simplicity,feasibility,generalizability,and accuracy,Kobayashi2018 score or Umakoshi model are recommended to predict IHA in Chinese population.