基于质谱法的坐位盐水抑制试验诊断原发性醛固酮增多症的适宜切点研究  

Study of appropriate cut-off for diagnosis of primary aldosteronism by seated saline suppression test based on liquid chromatography with tandem mass spectrometry

作　　者：张益鑫 宋颖[1] 胡金波[1] 杨淑敏[1] 冯正平[1] 何文雯[1] 李启富[1] 何一帆 Zhang Yixin;Song Ying;Hu Jinbo;Yang Shumin;Feng Zhengping;He Wenwen;Li Qifu;He Yifan(Department of Endocrinology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,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

出　　处：《中华内科杂志》2024年第1期66-73,共8页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金重点联合项目(U21A20355);国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项(2022YFC2505300,2022YFC2505301,2022YFC2505302,2022YFC2505306)。

摘　　要：目的探索基于质谱法诊断原发性醛固酮增多症(PA)的坐位盐水抑制试验(SSST)适宜切点。方法横断面研究。收集2018年1月至2022年3月就诊于重庆医科大学附属第一医院疑为PA而进行SSST的患者,包括PA患者300例、原发性高血压(EH)患者119例。采用液相色谱-串联质谱法(LC-MS/MS)测定SSST后血浆醛固酮浓度(PAC),以原发性醛固酮增多症确诊试验(PACT)评分作为诊断PA的参考标准,构建受试者工作特征曲线(ROC)并探索诊断PA的适宜切点。结果PA患者年龄(50.8±10.5)岁,男性159例(53.00%);EH患者年龄(49.4±11.2)岁,男性32例(26.89%)。SSST后PAC诊断PA的ROC曲线下面积为0.819(95%CI 0.775~0.862)。当选择PAC 40 pg/ml(110.8 pmol/L)作为诊断PA的适宜切点时,敏感度为83.67%(95%CI 78.88%~87.56%),特异度为60.50%(95%CI 51.10%~69.21%),95.09%(155/163)的单侧PA患者能够被识别。结论质谱法测定SSST后PAC对PA具有较高的诊断效能,推荐将40 pg/ml作为适宜切点。Objective To investigate the appropriate cut-off for diagnosis of primary aldosteronism(PA)by seated saline suppression test(SSST)based on liquid chromatography with tandem mass spectrometry(LC-MS/MS).Methods In this cross-sectional study,patients who underwent SSST for suspected PA in the First Affiliated Hospital of Chongqing Medical University from January 2018 to March 2022 were evaluated.Briefly,300 patients with PA and 119 with essential hypertension(EH)were included.Plasma aldosterone concentration(PAC)after SSST was determined by LC-MS/MS.Primary aldosteronism confirmatory testing(PACT)score was used as the reference standard for diagnosis of PA,and receiver operating characteristic(ROC)curve was used to explore the cut-off value.Results The average age of the PA group was(50.8±10.5)years,and males accounted for 53.00%(n=159);the average age of the EH group was(49.4±11.2)years,and males accounted for 26.89%(n=32).The area under the ROC curve of PAC post-SSST was 0.819(95%CI 0.775-0.862).When 40 pg/ml(110.8 pmol/L)was selected as the appropriate cut-off for diagnosis of PA,the sensitivity was 83.67%(95%CI 78.88%-87.56%)and specificity was 60.50%(95%CI 51.10%-69.21%).Thus,95.09%(155/163)of patients with unilateral PA could be identified.Conclusion PAC after SSST determined by LC-MS/MS has high efficacy for diagnosis of PA,and 40 pg/ml is recommended as the appropriate cut-off value.

关 键 词：醛固酮增多症 质谱分析法 坐位盐水抑制试验 切点 

分 类 号：R586.24[医药卫生—内分泌]