在高血压患者中筛选原发性醛固酮增多症国人血浆醛固酮/肾素活性比值标准的探讨  

Aldosterone-to-renin ratio threshold for screening primary aldosteronism in Chinese hypertensive patients

作　　者：陈绍行[1] 杜月凌[1] 张瑾[1] 龚艳春[1] 胡亚蓉[1] 初少莉[1] 何清波[2] 宋艳艳[2] 朱鼎良[1] 

机构地区：[1]上海交通大学医学院,瑞金医院高血压科200025 [2]上海交通大学医学院医学统计教研室

出　　处：《中华心血管病杂志》2006年第10期868-872,共5页Chinese Journal of Cardiology

基　　金：上海市高等学校科学技术发展基金(03BK13)

摘　　要：目的血浆醛固酮/血浆肾素活性比值(ARR)测定是目前从高血压患者中检出原发性醛固酮增多症(原醛)患者最常用和有效的筛选方法。ARR 值在不同人种中有很大差别,测定条件对其结果影响较大。本研究在严格控制药物、体位等条件下,建立中国人筛选原醛 ARR 值。方法根据肾上腺增强 CT 检查结果,将110例高血压患者分为原发性高血压组(65例)和肾上腺腺瘤/增生组(45例)。停用对肾素和醛固酮分泌有影响的降压药物至少2周,利尿剂包括螺内酯停用4周。对于不宜停服降压药物的患者,改服非双氢吡啶类钙拮抗剂维拉帕米缓释片(varapamil-SR)和(或)α受体阻滞剂特拉唑嗪(terazosin)。低血钾患者补钾至正常水平。采血日晨起保持立位2 h 后,于上午9～10点立位取肘静脉血测定血浆肾素活性、血浆醛固酮浓度,计算 ARR。结果 ARR 值以醛固酮 pg/ml/肾素活性 ng·ml^(-1)·h^(-1)为单位。立位 ARR 值在原发性高血压组为100.00±48.65,肾上腺腺瘤/增生组为699.33±213.33。由 ROC 曲线所得切割值为240,立位 ARR 较卧位 ARR 更有筛查价值。在肾上腺腺瘤/增生组93.3%(42/45)患者的 ARR 值高于240,原发性高血压组90.7%(59/65)患者ARR 值低于该值。取 ARR 值240为切割点,我们从近178例高血压患者中检出15例原醛患者(手术病理证实),所有15例患者 ARR 均大于240,显示极高的敏感性和特异性。结论采用本研究试验条件,中国人立位 ARR 值为240。ARR 测定是一项简便、有效的原醛筛查方法,测定时须注意体位、药物、血钾的影响。Objective In recent years, the assessment of the plasma aldosterone-to-renin ratio （ARR） has become a most effectively and commonly used method for screening primary aldosteronism from hypertensive patients. It is known that there is a large variance in ARR value between races and ARR is affected by many factors, such as drugs, posture and serum potassium etc. The objective of this study is to establish the threshold of ARR for screening primary aldosteronism in Chinese hypertensive patients. Methods A total of 110 hypertensive patients were recruited and divided into essential hypertension group （n = 65 ） and adenoma/hyperplasia group （n = 45 ） according to the adrenal contrast CT scan. Antihypertensive drugs which can affect ARR such as β-blockers, dihydropyridine calcium channel blockers （ CCBs）, ACE inhibitors （ ACEIs）, angiotensin Ⅱ receptor blockers （ARBs） and clonidine, were withdrawn for at least 2 weeks. Washout period for diuretics including spironolactone were 4 weeks. Nondihydropyridine calcium channel blockers （ slow released varapamil） and/or α-blocker （ terazosin ） are allowed for controlling blood pressure when needed. If the serum potassium value 〈 3. 6 mmol/L, an oral potassium supplement was prescribed. After keeping upright position for 2 hours, blood samples were drawn for PRA and PAC measurement between 9：00AM-10：00AM. Results ARR was 100. 00 ±48. 65 （ 14. 19- 285. 16） pg/ml vs ng· ml^-1· h^-1 in patients with essential hypertension and 699. 33 ±213.33 （185.8 -2150） pg/ml vs ng · ml^-1· h^-1 in patients with adenoma/hyperplasia. ARR value was greater than 240 in 42 out of 45 patients （93.3%） with adenoma/hyperplasia and was less than 240 in 59 out of 65 （90. 7% ） patients with essential hypertension. We used ARR 240 as the cut-off threshold for screening primary aldostemnism in another 178 hypertensive patients and ARR was greater than 240 in all 15 patients with confirmed primary aldosteronism. Conclusion It is suitable to use

关 键 词：醛固酮增多症 高血压 醛固酮/肾素比值 

分 类 号：R544.1[医药卫生—心血管疾病]