醛固酮瘤患者的血浆肾素水平及分布  

Distribution characteristics of plasma renin concentration in patients with aldosterone-producing adenoma

作　　者：梁佳雨 荆颖 申航 陈香均 骆文锦 宋颖[1] 王越[1] 胡金波[1] 杨淑敏[1] 吴飞飞[2] 李启富[1] Liang Jiayu;Jing Ying;Shen Hang;Chen Xiangjun;Luo Wenjin;Song Ying;Wang Yue;Hu Jinbo;Yang Shumin;Wu Feifei;Li Qifu(Department of Endocrinology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Endocrinology,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046099,China)

机构地区：[1]重庆医科大学附属第一医院内分泌科,重庆400016 [2]长治医学院附属和平医院内分泌科,长治046099

出　　处：《中华内科杂志》2023年第8期972-978,共7页Chinese Journal of Internal Medicine

基　　金：国家重点研发计划(2022YFC2505301,2022YFC2505302,2022YFC2505306);国家自然科学基金重点联合项目(U21A20355)。

摘　　要：目的:分析醛固酮瘤(APA)患者血浆肾素浓度(PRC)的分布特点以及其对诊断的影响。方法:回顾性病例系列研究。纳入2013年11月至2022年1月在重庆医科大学附属第一医院内分泌科确诊为APA的200例患者,收集其临床资料,其中男性80例,女性120例;平均年龄45.6岁。血浆PRC测定采用自动化学发光免疫分析法。分析PRC的分布特点,并以8.2 mU/L为切点评估患者是否存在肾素分泌被抑制。结果:200例APA患者PRC的中位数为1.6 mU/L(范围为0.4~41.5 mU/L),其中PRC≤2 mU/L者最多,为116例;其次为2<PRC≤4 mU/L者,共41例。8.0%(16/200)APA患者PRC未被抑制(>8.2 mU/L)。其中,2.5%(5/200)的APA患者因PRC未被抑制使醛固酮/肾素比值偏低,导致原发性醛固酮增多症筛查假阴性。结论:大部分APA患者血浆肾素低,但仍有小部分(8%)患者血浆肾素未被充分抑制,可导致其中一些患者筛查时漏诊。对于高度疑似原发性醛固酮增多症的病例,即使筛查时肾素不低,仍需进一步检查以明确诊断。ObjectiveTo analyze the distribution characteristics of plasma renin concentration(PRC)in patients with aldosterone-producing adenoma(APA)and its impact on diagnosis.MethodsIn this retrospective case series,clinical data from 200 patients with APA(80 men and 120 women;mean age 45.6 years)in the First Affiliated Hospital of Chongqing Medical University from November 2013 to January 2022 were evaluated.PRC was determined by automated chemiluminescence immunoassay.The distribution characteristics of PRC were analyzed,and 8.2 mU/L was used as the low renin cutoff to evaluate whether renin was suppressed.ResultsThe median PRC was 1.6 mU/L(range,0.4-41.5 mU/L).There were 116 patients with APA with PRC of≤2 mU/L,41 patients with 2<PRC≤4 mU/L.PRC was not suppressed(PRC>8.2 mU/L)in 8.0%(16/200)of the patients with APA.And PRC was not suppressed in 2.5%(5/200)of the patients with APA,resulting in a primary aldosteronism negative screening outcome.ConclusionsAlthough most patients with APA have low PRC,there are a small number(8%)of patients whose PRC has not been fully suppressed,which can lead to missed diagnoses during primary aldosteronism screening.While primary aldosteronism is highly suspected,further investigations are required to determine the diagnosis,even if PRC is not fully suppressed at screening.

关 键 词：醛固酮增多症 肾素 原发性醛固酮增多症 醛固酮瘤 

分 类 号：R586.24[医药卫生—内分泌]