24小时尿18-羟皮质醇含量对于不同性别肾上腺醛固酮腺瘤患者的诊断价值  

Diagnostic Value of 24-hour Urinary 18-Hydroxycortisol for Aldosterone-producing Adenomas in Male and Female Patients

作　　者：胡志成[1] 卞瑾[1] 娄莹[1] 周宪梁[1] 张慧敏[1] 蔡军[1] 马文君[1] 赵蓓蓓 饶梦华 佘旭辉 HU Zhicheng;BIAN Jin;LOU Ying;ZHOU Xianliang;ZHANG Huimin;CAI Jun;MA Wenjun;ZHAO Beibei;RAO Menghua;SHE Xuhui(Department of Cardiology,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,阜外医院心内科,北京市100037 [2]广州医科大学金域检验学院,广州金域医学检验中心有限公司

出　　处：《中国循环杂志》2022年第10期1023-1028,共6页Chinese Circulation Journal

摘　　要：目的:探讨24 h尿18-羟皮质醇(18-OHF)含量对于不同性别肾上腺醛固酮腺瘤(APA)患者的诊断价值。方法:连续入选2019年7月至2020年6月于中国医学科学院阜外医院已确诊亚型的73例原发性醛固酮增多症(原醛症)患者。收集患者一般临床资料,采用液相色谱串联质谱法检测24 h尿18-OHF含量。采用单因素Logistic回归分析明确24 h尿18-OHF含量与不同性别原醛症患者诊断APA的相关性。通过ROC曲线评价24 h尿18-OHF含量对APA的诊断价值。结果:73例原醛症患者中,女性患者30例[特发性醛固酮增多症(IAH)14例、APA 16例],男性患者43例(IAH 11例、APA 32例)。对于女性,APA患者24 h尿18-OHF含量高于IAH患者[450(260,779)nmol/d vs.220(123,276)nmol/d,P<0.05];对于男性,APA患者与IAH患者24 h尿18-OHF含量差异无统计学意义[376(242,537)nmol/d vs.251(168,384)nmol/d,P>0.05]。Logistic回归分析显示,24 h尿18-OHF含量为女性和男性原醛症患者诊断APA的预测因素(P<0.01,P<0.05)。ROC曲线分析显示:在女性患者中,以24 h尿18-OHF含量>298 nmol/d为诊断APA的临界值(AUC:0.74,95%CI:0.55~0.93,P<0.05),灵敏度和特异度分别为68.8%和85.7%;在男性患者中,以24 h尿18-OHF含量>205 nmol/d为诊断APA的临界值(AUC:0.67,95%CI:0.48~0.87,P>0.05),灵敏度和特异度分别为87.5%和45.5%。结论:24 h尿18-OHF含量对于女性APA诊断具有的一定价值,特异度较高。Objectives:To investigate the diagnostic value of 24-hour urinary 18-hydroxycortisol(18-OHF)for aldosteroneproducing adenomas(APA)in male and female patients with primary aldosteronism(PA).Methods:Consecutive PA patients diagnosed with confirmed subtype from July 2019 to June 2020 in Fuwai Hospital were recruited.The general data and clinical characteristics of patients were collected.The 24-hour urine 18-OHF contents were detected by liquid chromatography tandem mass spectrometry.Regression analysis was performed to determine the relationship between 24-hour urinary 18-OHF and APA.Diagnostic value of 24-hour urinary 18-OHF was evaluated by ROC curve.Results:Seventy-three patients were included.There were 14 female patients with idiopathic hyperaldosteronism(IAH)and 16 female patients with APA,11 male patients with IAH and 32 male patients with APA.The contents of 24-hour urinary 18-OHF were higher in female patients with APA than female patients with IAH(450[260,779]nmol/d vs.220[123,276]nmol/d,P<0.05).Contents of 24-hour urinary 18-OHF were similar between male APA and male IAH patients(376[242,537]nmol/d vs.251[168,384]nmol/d,P>0.05).The regression analysis showed that 24-hour urinary 18-OHF was a predictor for APA in female and male patients with PA(P<0.01,P<0.05).In female PA patients,the AUC of 24-hour urinary 18-OHF for diagnosis of APA was 0.74(95%CI:0.55-0.93,P<0.05).The sensitivity and specificity were 68.8% and 85.7%,respectively with the cut-off value of>298 nmol/d.In male PA patients,the AUC of 24-hour urinary 18-OHF for diagnosis of APA was 0.67(95%CI:0.48-0.87,P>0.05).The sensitivity and specificity were 87.5% and 45.5% respectively with the cut-off value of>205 nmol/d.Conclusions:The content of 24-hour urinary 18-OHF is valuable for APA diagnosis in female PA patients with high specificity.

关 键 词：18-羟皮质醇 醛固酮腺瘤 性别 诊断价值 

分 类 号：R54[医药卫生—心血管疾病]