卡托普利抑制试验给药后不同时间测定的醛固酮水平对原发性醛固酮增多症患者诊断的价值  

Value of Plasma Aldosterone Concentration Measured at Different Time Points in Captopril Challenge Test in the Diagnosis of Primary Aldosteronism

作　　者：郭超[1] 卞瑾[1] 蒋萍[1] 郝素芳[1] 娄莹[1] 张慧敏[1] 周宪梁[1] 蔡军[1] 马文君[1] GUO Chao;BIAN Jin;JIANG Ping;HAO Sufang;LOU Ying;ZHANG Huimin;ZHOU Xianliang;CAI Jun;MA Wenjun(Hypertension Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院高血压中心,北京市100037

出　　处：《中国循环杂志》2022年第7期731-737,共7页Chinese Circulation Journal

摘　　要：目的:探讨卡托普利抑制试验(CCT)中给药后不同时间测定的血浆醛固酮水平(PAC)对原发性醛固酮增多症(PA)患者诊断的价值。方法:纳入2019年1月至2020年6月于中国医学科学院阜外医院高血压中心住院筛查的继发性高血压患者45例,其中男性18例(40%),女性27例(60%),平均年龄(50.60±10.33)岁。立位试验醛固酮/肾素值(ARR)≥2.4(ng/dl)/(μIU/ml),需进一步行CCT的患者共45例,根据2 h CCT法将患者分为PA组和非PA组。于给药前及给药后1 h、1.5 h及2 h抽血化验PAC、直接肾素浓度(DRC)、皮质醇(COR)水平。结果:PA组患者20例,非PA组患者25例。两组患者的PAC、ARR变化均在给药后随采血间隔时间延长呈下降趋势,DRC在给药后随采血间隔时间延长呈上升趋势(P均<0.001),这种差异主要由0-1 h的差异所产生(P均<0.05),而1-1.5 h、1.5-2 h之间的PAC、 DRC、ARR变化差异均无统计学意义(P均>0.05)。PAC 1 h及PAC 1.5 h截断点均为9.95 ng/dl,灵敏度分别为90%、95%,特异度分别为92%、96%,AUC分别为0.945和0.970,Kappa值分别为0.820和0.910。结论:在进行CCT过程中,给药后1 h或1.5 h测定PAC≥9.95 ng/dl,可作为PAC 2 h的代替指标对PA患者进行确诊,具有较好的拟合度及区分度,进而简化CCT流程,减少患者抽血次数。Objectives: To investigate the accuracy of plasma aldosterone concentration(PAC) measured at different time points after administration of captopril in a captopril challenge test(CCT) in the diagnosis of primary aldosteronism(PA).Methods: Our study enrolled 45 patients with hypertension and an aldosterone renin ratio(ARR) over 2.4(ng/dl)/(μIU/ml),who were admitted to our hospital between Jan 2019 to June 2020. Blood samples were collected before administration and 1 h,1.5 h and 2 h after the CCT, respectively, for the measurement of PAC, direct renin concentration and cortisone.Results: According to the 2 h CCT method, 20 patients were diagnosed as PA and 25 patients were diagnosed as nonPA. Compared with non-PA patients, PA patients had higher prevalence of hypertension history, longer medical history,lower serum potassium, higher urine potassium, and higher urine aldosterone(ALD) levels;PAC(P=0.009 and P<0.001,respectively) and ARR(P=0.001 and P<0.001, respectively) showed a decreased trend with the extension of blood sampling interval after CCT in both PA and non-PA groups, while DRC showed an increased trend with the extension of blood sampling interval after administration of captopril(P<0.001), which was mainly caused by the difference of 0-1 h(P1 h<0.005, P<0.001),and there was no statistical difference in the changes of PAC, DRC, and ARR from 1 h to 1.5 h and 1.5 h to 2 h. The cut-off values of PAC 1 h and PAC 1.5 h were both 9.95 ng/dl, the sensitivity was 90% and 95%, the specificity was 92% and 96%,the area under the ROC curve was 0.945 and 0.970, and the Kappa value was 0.820 and 0.910, respectively.Conclusions: In the process of CCT, the measurement of PAC≥9.95 ng/dl at 1 h or 1.5 h after administration of captopril can be used as a surrogate index for PAC 2 h to diagnose PA patients. The diagnostic performance is satisfactory and could simplify the CCT workflow and reduce the blood sampling times.

关 键 词：原发性醛固酮增多症 卡托普利 确诊试验 时间因素 

分 类 号：R541.4[医药卫生—心血管疾病]