肾上腺醛固酮瘤的肾素和醛固酮及其比值的分析  

Analysis of characteristics of renin, aldosterone and aldosterone/renin ratio in patients with aldosterone-producing adenoma

作　　者：贺冶冰[1] 余虓[2] 周新荣[1] 舒柏华[3] 刘继红[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院内分泌科,武汉430030 [2]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030 [3]华中科技大学同济医学院公共卫生学院检验中心

出　　处：《中华医学杂志》2013年第42期3379-3383,共5页National Medical Journal of China

摘　　要：目的 探讨肾上腺醛固酮瘤（APA）血浆肾素活性（PRA）和醛固酮水平（PAC）及PAC/PRA比值（ARR）的特点.方法 回顾性分析2006年3月至2012年3月华中科技大学同济医学院附属同济医院内分泌科和泌尿外科80例经手术证实的APA和70例原发性高血压病（EH）的数据,分为标准化筛查组（简称标化组）和用药组,26名正常血压者为对照（正常血压组）.受试者工作特征曲线（ROC）探讨最佳ARR和低PRA切点值.结果 正常血压组和EH标化组：90%～95%卧位和100%立位PRA≥0.52 ng·ml-1·h-1（1 ng·ml-1·h-1=1 μg·L-1·h-1）.APA标化组：≥90% PRA〈0.52 ng·ml-1·h-1;最低ARR（为计算方便,PAC单位选用ng/dl,1 ng/dl=27.7 pmol/L;ARR单位选用ng·dl-1/ng·ml-1·h-1）：卧位≥24.2,立位≥37.5.筛查APA最佳ARR （ng·dl-1/ng·ml-1·h-1）：卧位≥26.0,立位≥37.0;低PRA （ng·ml-1·h-1）切点值：卧位〈0.50,立位〈0.63.盐水负荷后PAC≥10.0 ng/dl,诊断敏感度88.2%,特异度61.5%.降压药干扰PRA和ARR测定,对盐水负荷后PAC无影响.结论 PRA和PAC及ARR以排除诊断APA为特点.APA存在明确的低PRA切点值.Objective To characterize the plasma renin activity （PRA） and plasma aldosterone concentration （PAC） and aldosterone/renin ratio （ARR） in patients with aldosterone-producing adenoma （APA）. Methods We retrospectively analysed the data of PRA, PAC and ARR from 80 patients with APA, 70 patients with essential hypertension （EH） and 26 individuals with normal blood pressure （NBP）. Patients with hypertension were further divided into taking anti-hypertensive drug group （D） and non drug treatment group （ND）. All participants received at least one following tests ： ARR screening test, supineupright position test and saline load test. Receiver-operating characteristic （ROC） analysis was used for exploring the best cut-off value of ARR and low PRA. Results The median and percentages of PRA （ng·ml-1·h-1, 1 ng·ml-1·h-1 =1 μg·L-1·h-1）, PAC （ng/dl, 1 ng/dl =27.7 pmol/L） and ARR （ng·ml-dl-1/ng·ml-1·h-1） between NBP and EH （ND） groups showed no differences. Over 90% supine PRAy〉0. 52 and 100% upright PRA ≥0. 52 in the above two groups. On the contrary, 90% APA （ND） patients upright PRA 〈 0. 52. The lowest supine and upright ARR in APA （ND） patients was I〉 24. 2 and I〉 37.5 respectively. ROC analysis suggested that the best screening cut-off values for APA were supine ARR ≥26. 0, upright ARR ≥37.0; and low PRA cut-off value for APA were supine PRA 〈0. 50 and upright PRA 〈0. 63 respectively. The sensitivity and specificity for APA diagnosis were about 88.2% and 61.5% when PAC ≥ 10. 0 after saline load test. Conclusions The distinguishing features of PRA, PAC and ARR can be used as a diagnostic indexs for the exclusive diagnosis of APA in various clinical tests. And low PRA cut-off values exist in APA patients.

关 键 词：醛固酮增多症 肾素 醛固酮 筛查试验 确诊试验 

分 类 号：R736.6[医药卫生—肿瘤]