应用血浆肾素浓度进行原发性醛固酮增多症筛查的评价及不同体位筛查效率的比较  

Using plasma renin concentration to screen primary aldosteronism in hypertensive patients and to observe the effect of posture

作　　者：鄞国书[1] 张少玲[1] 吴木潮[1] 黎锋[1] 徐明彤[1] 陈黎红[1] 程桦[1] 严励[1] 

机构地区：[1]广州中山大学孙逸仙纪念医院内分泌科,510120

出　　处：《中华内分泌代谢杂志》2010年第8期646-650,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：“十五”国家科技攻关计划（2004BA720A29）;广东省科技厅国际合作项目（2008B050100010）

摘　　要：目的比较应用血浆醛固酮／血浆肾素活性（PAC／PRA，ARR）及PAC/血浆肾素浓度（PAC／PRC，AARR）进行原发性醛固酮增多症（PA）筛查的特异性和敏感性差异，评价测定m浆肾素浓度在PA筛查中的价值，并比较不同体位下AARR的筛查效率。方法（1）对28例通过确诊试验或手术病理证实的PA患者和51例原发性高血压患者测定卧位、立位1h和立位2h的AARR，比较不同体位和时间下测定的AARR在PA筛查中的效率。（2）财31例PA患者、242例原发性高血压患者及145名健康志愿者测定立位1hPAC、PRA和PRC，计算ARR和AARR，通过构建ARR和AARR对诊断PA的受试者工作特征曲线（ROC），比较两者在PA筛查中的敏感性和特异性，探讨AARR在筛查PA中的价值，并确定最佳的切点。结果（1）卧位、立位1h和立位2hAARR的ROC曲线下面积分别是0．950（95％d0．906～0．994，P〈0．01）、0．979（95％CI 0．956-1．000，P〈0．01）和0．917（95％CI 0．856～0．979，P〈0．01）。立位1h AARR具有最高的筛查效率。（2）立位1h Log—PRA和Log—PRC相关系数为0．705，Log—ARR和Log—AARR的相关系数为0．788。ARR和AARR的ROC曲线下面积分别为0．998（95％C10．981～1．000，P〈0．01）和0．957（95％C10．929—0．985，P〈0．01）。AARR的最佳切点为42．36ng·dl^-1／ng·dl^-1，其敏感性和特异性分别达到87．10％和93．75％。结论应用AARR和ARR在高血难患者中进行PA的诊断效果相当，以立位1h测定的AARR具有最佳的筛查效率，最佳切点为42．36ng·dl^-1／ng·dl^-1。Objective Plasma renin concentration （PRC） offers advantages in processing and standardization as compared with plasma renin activity （PRA）. The aim of the study is to compare the sensitivity and specificity of plasma aldosterone concentration （ PAC）/PRA （ARR） and PAC/PRC （AARR） in screening primary aldosteronism （PA） in hypertensive patients and to observe the influence of different postures on PRC and AARR. Method （ 1 ） PAC and PRC in the supine position and after 1-hour and 2-hour upright posture were determined in 28 patients with PA and 51 patients with essential hypertension. The diagnostic efflcacies during different postures were compared according to the ROC carve analysis. （2） 31 patients with PA, 242 patients with essential hypertension, and 145 normotensitive subjects were recruited in the study. The diagnostic efficacy of AARR in screening PA from hyperlensive patients was evaluate. PAC, PRA, and PRC were measured by radioimmunoassay. Results （ 1 ） The AUC of AARR in the st, pine position, 1 -hour and 2-hour upright posture were0.950 （95%C10.906-0.994, P〈0.01）, 0.979 （95% C10.956-1.000, P〈0.01） and 0.917 （95%CI 0. 856-0. 979, P〈0.01 ） respectively. AARR of 1-hour upright yielded the highest screening efficiency. （2） The correlation coefficient index of Log-PRA and Log-PRC was 0. 705 （P〈0.01 , n = 418 ） , whereas the correlation coefficient index of Log-ARR and Log-AARR was 0. 705 （P〈0.01, n =418）. The AUC of ARR and AARR were 0.998 （95% CI 0. 981-1. 000, P〈0.01 ） and 0. 957 （ 95% CI 0. 929-0. 985, P〈0.01 ） respectively according to the ROC curve. The optimal cutoff of AARR during upright 1 hour was 42. 36 ng·dl^-1/ng^-1·dl^-1 （ sensitivity 87.10% , specificity 93.75% ）. Conclusion The screening efficacy of AARR in screening PA in hypertensive patients was comparable with ARR. AARR measured after keeping upright 1 hour yielded the highest screening efficiency. The optimal cutoff of AARR was 42.36 ng·dl^-1/ng·dl

关 键 词：原发性醛固酮增多症 醛固酮 肾素 高血压 

分 类 号：R586.24[医药卫生—内分泌]