卡托普利试验过程中血浆醛固酮水平的变化特点及意义  

Characteristics and significance of plasma aldosterone levels during captopril test

作　　者：雷永富[1] 李敏[1] 沈琼娜 宫景莲 刘中银 吴贻竟 李梓[1] 王蕾[1] 郭娟 LEI Yon;L.I Min;SHEN Qiongna;GONG Jinglian;LIU Zhongyin;WU Yijing;LI Zi;WANG Lei;GUO Juan(Department of Endocrinology,Bengbu First People's Hospital,Anhui Province,Bengbu 233000,China)

机构地区：[1]安徽省蚌埠市第一人民医院内分泌科,233000

出　　处：《疑难病杂志》2018年第12期1338-1342,1346,共6页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的观察卡托普利试验过程中血浆醛固酮水平变化特点及意义。方法选择2015年1月—2017年12月安徽省蚌埠市第一人民医院内分泌科住院进行高血压病因筛查的患者为研究对象。所有受试者入院后均收集相关的病史,行常规体检及相关的实验室检查,包括原发性醛固酮增多症(PA)、库欣综合征、嗜铬细胞瘤及其他相关检查,排除其他继发性高血压,符合PA诊断者为PA组,其他患者为原发性高血压(EH)组。立位醛固酮与肾素活性的比值(ARR)≥300 pg·ml^(-1)/ng·ml^(-1)·h^(-1)者行卡托普利试验。比较卡托普利试验过程中组间醛固酮水平的变化。结果 (1)服用卡托普利前,PA组醛固酮水平及ARR均高于EH组(Z=-3.617、-3.879,P=0.000、0.000),服用卡托普利后,PA组醛固酮水平及ARR仍均高于EH组(Z=-3.076、-3.186,P=0.002、0.001);服用卡托普利前后,PA组肾素活性均低于EH组(Z=-2.538、-2.223,P=0.011、0.026)。(2)全部研究对象中,服用卡托普利后血浆醛固酮水平不降反升的患者比例为59.6%,且EH组患者占比高于PA组(χ~2=4.195,P=0.041)。(3)服用卡托普利后,全部患者中醛固酮抑制率>5%、>10%及>12%的患者比例分别为30.4%、26.8%及20.5%,且PA组高于EH组(χ~2=5.483、5.986、6.137,P=0.019、0.014、0.013);醛固酮抑制率>15%、>20%、>25%、>30%的患者比例分别为15.2%、9.0%、8.0%、6.3%,且2组间差异无统计学意义(χ~2=3.111、0.401、0.947、1.260,P=0.078、0.527、0.324、0.262)。结论 (1)卡托普利试验过程中,90%以上的患者醛固酮抑制率<20%。(2)按照目前国内的PA专家共识,通过卡托普利试验对PA与EH进行有效的鉴别有一定的难度。Objective To observe the characteristics and significance of plasma aldosterone levels during captopril test.Methods The subjects were selected from January 2015 to December 2017 in the Department of Endocrinology of the First People's Hospital of Bengbu City,Anhui Province.After admission,all subjects were given routine physical examinations and laboratory examinations,including primary aldosteronism (PA),Cushing's syndrome,pheochromocytoma and other related examinations.Other secondary hypertension was excluded.Those who met the diagnosis of PA were PA group,and the other patients were essential hypertension (EH)group.Captopril test was performed in patients with the ratio of orthostatic aldosterone to renin activity (ARR)>300pg·ml^-1/ng·ml^-1·h^-1.To compare the changes of aldosterone levels between groups during captopril test.Results (1).Before taking captopril,the aldosterone level and ARR of PA group were higher than those of EH group (Z =-3.617,Z =-3.879,P =0.000,P =0.000).After taking captopril,the aldosterone level and ARR of PA group were still higher than those of EH group (Z =-3.076,Z =-3.186,P =0.002,P =0.001);before and after taking captopril,the renin activity of PA group was lower than that of EH group (Z =-2.538,Z =-2.223,P = 0.011,P =0.026).(2)Among all the subjects,59.6% of the patients whose plasma aldosterone level'did not decrease and rose after taking captopril,and the proportion of EH group was higher than that of PA group (χ^2=4.195,P =0.041).(3). After taking captopril,the proportions of patients with aldosterone inhibition rates of >5%,>10% and >12% were 30..4%,26.8%and 20.5%respectively,and those in PA group were higher than those in EH group (χ^2=5.483,χ^2=5.986,χ^2=6.137,P =0.019,P =0.014,P =0.013),and those with aldosterone inhibition rates of >15%,20%,25% and >30% were 15.2%,9.0%,8.0%,6.137,respectively.3% and there was no significant difference betweer/the two groups (χ^2=3.111,χ^2=0.401,χ^2=0.947,χ^2=1.260,P=0.078,P=0.527,P=0.324,P=0.262).Conclusion (1)During captopri

关 键 词：卡托普利试验 醛固酮 抑制率 

分 类 号：R586.24[医药卫生—内分泌]