原发性醛固酮增多症中不同筛查和确诊试验的应用及评价  

Application and evaluation of screening and confirmatory tests for the diagnosis of primary aldosteronism

作　　者：江敏纯 马杜娟 唐菊英[1] 林海伦[1] 邓亚娟 郭颖[1] 张少玲[1] 严励[1] JIANG Min-chun , MA Du-juan, TANG Ju-ying, LIN Hai-lun, DENG Ya-juan, GUO Ying, ZHANG Shao-ling, YAN Li(Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital,Sun Yat-sen University, Guangzhou Guangdong 510120, Chin)

机构地区：[1]中山大学孙逸仙纪念医院内分泌科,广东广州510120 [2]广州市番禺中心医院内分泌科 [3]南方医科大学深圳医院内分泌科

出　　处：《中华高血压杂志》2018年第2期138-143,共6页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81471011)

摘　　要：目的比较血浆醛固酮与肾素活性比值(ARR)、卡托普利试验(CCT)及盐水负荷试验(SIT)在原发性醛固酮增多症(PA)中的诊断效率。方法回顾性连续纳入2008年8月至2016年6月在中山大学孙逸仙纪念医院内分泌科住院的原发性高血压(EH)患者183例及PA患者105例的临床资料,利用受试者工作特征(ROC)曲线分析不同试验的诊断效率。结果共288例行筛查试验,基础ARR切点为27.2(ng/dL)/[μg/(L·h)]时,敏感性为86.7%,特异性为90.7%。261例行CCT,试验后血浆醛固酮浓度(PAC)、PAC抑制率(%)及ARR的ROC曲线下面积分别为0.876(95%CI0.828~0.924,P<0.001)、0.691(95%CI 0.621~0.760,P<0.001)和0.932(95%CI0.898~0.966,P<0.001),三者比较,CCT后ARR的诊断效率最高(P<0.001)。108例行SIT,试验后PAC及ARR的ROC曲线下面积分别为0.795(95%CI 0.675~0.915,P<0.001)和0.915(95%CI 0.838~0.991,P<0.001),SIT后ARR的诊断效率更高(P<0.05)。102例同时行CCT和SIT,一致性检验Kappa值为0.715(P<0.001);比较CCT后ARR、SIT后ARR及联合两指标的ROC曲线下面积,三者间差异无统计学意义。结论基础ARR筛查效率较高;CCT后ARR及SIT后ARR具有较高的诊断效率,两者一致性较好,但联合两者未能提高诊断效率。Objective To investigate the diagnostic efficieneies of baseline plasma aldosterone to renin ratio （ARR）, captopril challenge test （CCT） and saline infusion test （SIT） on primary aldosteronism （PA）. Methods A total of 183 patients with essential hypertension （EH） and 105 with PA hospitalized at Sun Yat-sen Memorial Hospital of Sun Yat-Sen University from August 2008 to June 2016 were enrolled in the study, and their clinical data were ana- lyzed by receiver operating characteristics （ROC） curve for comparing the accuracies of screening and confirmatory tests. Results A total of 288 patients underwent screening test. For ARR at a cut-off value of 27.2 （ng/dL）/ [μg/（ L · h）], the sensitivity and specificity were 86.7 % and 90.7 %, respectively. The CCT was performed in 261 patients. Post-CCT, the AUCs of plasma aldosterone concentration （PAC）, suppression rate of PAC and ARR were 0.876 （95% CI 0.828-0.924, P〈0.001）, 0.691 （95% CI 0.621-0.760, P〈0.001） and 0.932 （95% CI 0. 898-0. 966, P%0. 001） respectively with the accuracy of ARR post-CCT the highest （P〈0. 001 ）. A total of 108 patients underwent SIT. Post-SIT, the AUCs of PAC and ARR were 0. 795 （95% CI 0. 675-0. 915, P〈0. 001） and 0. 915 （95% CI 0. 838-0. 991, P〈0. 001） respectively with ARR a higher accuracy （P〈0.05）. A total of 102 patients underwent both CCT and SIT. In the consistency check of CCT and SIT, Kappa value was 0. 715 （P〈0. 001 ）. Comparing the AUCs of ARR post-CCT, ARR post-SIT, serial test of ARR post-CCT and ARR post-SIT, there were no statistical differences among the three indices. Conclusion The detecting efficiency of baseline ARR is satisfactory. With a good consistency, CCT and SIT are both efficient confirmatory tests for PA, however combining CCT and SIT did not improve the accuracy for diagnosis of PA.

关 键 词：原发性醛固酮增多症 血浆醛固酮与肾素活性比值 卡托普利试验 盐水负荷试验 受试者工作 特征曲线 

分 类 号：R586.24[医药卫生—内分泌]