尿醛固酮与不同体位血浆肾素活性比值对原发性醛固酮增多症的筛查价值  

Evaluating the significance of urinary aldosterone-to-active renin ratio for primary aldosterone screening

作　　者：朱杰 赵玲[2] 王琳[2,3] 范晓静[2] 贾晓蒙[2] 臧丽[2] 杨国庆[2] 谷伟军[2] 杜锦[2] 王先令[2] 郭清华[2] 吕朝晖[2] 巴建明[2] 窦京涛[2,4] 母义明[2] ZHU Jie;ZHAO Ling;WANG Lin;FAN Xiao-jing;JIA Xiao-meng;ZANG Li;YANG Guo-qing;GU Wei-junz;DUJin;WANG Xian-ling;GUO Qjng-hua;LV Zhao-hui;BA Jian-rning;D OU Jing-tao;MU Yi-ming(Department of Endocrinology,Beijing Geriatric Hospital,Beijing 100095,China;Department of Endocrinology,Chinese PLA General Hospital,Beijing 100853p China;Department of First Internal Medicine,316 Hospital of Chinese PLA,Beijing 100093j China;Department of Endocrinology,Hainan Branch of Chinese PLA General Hospital,Sanya,Hainan 572013,China)

机构地区：[1]北京老年医院内分泌科,北京100095 [2]解放军总医院内分泌科,北京100853 [3]解放军316医院内一科,北京100093 [4]解放军总医院海南分院内分泌科,海南三亚572013

出　　处：《解放军医学杂志》2018年第7期569-573,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨24h尿醛固酮(UALD)与不同体位血浆肾素活性(PR A)比值(UARR,UARR=UALD/PR A)对原发性醛固酮增多症(PA)的筛查价值。方法回顾性分析2012年1月—2014年12月解放军总医院确诊的123例PA及155例原发性高血压(EH)患者的临床资料,分别计算UARR和不同体位血浆醛固酮与肾素活性比值(ARR),采用ROC曲线得出UARR的曲线下面积(AUC)、最佳切点,并与公认的筛查指标ARR进行比较。结果立位UARR的AUC为0.954,其最佳切点为14.20nmol/[μg/(L·h)],敏感性为91.87%,特异性为88.64%;卧位UARR的AUC为0.918,敏感性为78.05%,特异性为87.12%;立位UARR的AUC高于卧位(Z=2.572,P=0.01)。立位ARR的AUC为0.929,敏感性为85.88%,特异性为90.91%;卧位ARR的AUC为0.913,敏感性为84.55%,特异性为81.82%,立位UARR的AUC分别高于立、卧位ARR的AUC(Z=2.094,P=0.036;Z=2.675,P=0.008)。结论立位UARR与ARR同样是PA的一项有效筛查指标。Objective To explore the clinical value of 24 h urinary aldosterone-to-active renin ratio（UARR） in different postures for screening primary aldosteronism（PA）. Methods The clinical data were retrospectively analyzed of 123 PA and 155 essential hypertension（EH） patients admitted in Chinese PLA general hospital from Jan. 2012 to Dec. 2014. The UARR and plasma aldosterone-to-active renin ratio（ARR） in different postures were calculated, and the receiver operating characteristic（ROC） curve was applied to obtain the area under ROC curve（AUC） and the optimal cut-off point of UARR in different postures for PA screening, and all the results were compared with recognized screening parameters. Results The optimal cut-off point of erect UARR was 14.20 nmol/[μg/（L·h）], the AUC, sensitivity and specificity were 0.954, 91.87% and 88.64%, respectively; the AUC, sensitivity and specificity of clinostatasm UARR were 0.918, 78.05% and 87.12%, respectively; the AUC of UARR was larger in erect position than in clinostatic（Z=2.572, P=0.01）. The AUC, sensitivity and specificity of erect ARR were 0.929, 85.88% and 90.91%, respectively; and of clinostatic ARR were 0.913, 84.55% and 81.82%, respectively; the AUC of erect UARR was larger than the AUC of both erect and clinostatic ARR（Z=2.094, P=0.036; Z=2.675, P=0.008）. Conclusion Both erect position UARR and ARR are the effective parameters for screening PA.

关 键 词：原发性醛固酮增多症 尿醛固酮/肾素活性 筛查 

分 类 号：R586[医药卫生—内分泌]