醛固酮与直接肾素浓度比值筛查天津市高血压人群中原发性醛固酮增多症的最佳切点  

The optimal cut-off point of plasma aldosterone/renin ratio for screening primary aldosteronism among hypertensive population in Tianjin

作　　者：任亚女 查晓宇 董作亮[1] REN Yanv;ZHA Xiaoyu;DONG Zuoliang(Department of Clinical Laboratory,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院医学检验科,天津300052

出　　处：《中国慢性病预防与控制》2024年第11期827-831,836,共6页Chinese Journal of Prevention and Control of Chronic Diseases

摘　　要：目的 探讨采用血浆醛固酮浓度(PAC)与直接肾素浓度(DRC)比值(ARR)筛查天津地区高血压人群原发性醛固酮增多症(PA)的最佳切点,为PA的临床筛查诊断提供依据。方法 纳入2021年10月至2023年9月于天津医科大学总医院进行PA筛查的天津地区的高血压患者1075例,收集患者的临床资料及卧立位PAC、DRC、ARR水平。采用SPSS22.0软件进行t检验、秩和检验和χ^(2)检验,绘制受试者工作特征(ROC)曲线确定ARR筛查PA的最佳切点,并进一步分析不同性别、年龄和体质指数(BMI)患者ARR的切点变化。结果 1075例高血压患者中,PA为190例(17.67%),原发性高血压885例(82.33%)。筛查PA的立位ARR的ROC曲线下面积(AUC)为0.975(95%CI:0.966~0.984),最佳切点为2.98(ng/dl)/(m U/L),敏感度为94.86%,特异度为92.76%;卧位ARR的AUC为0.976(95%CI:0.967~0.985),最佳切点为4.36(ng/dl)/(m U/L),敏感度为93.71%,特异度为92.06%。分层分析显示,男性患者立位ARR的最佳切点为2.72(ng/dl)/(m U/L),敏感度为96.74%,特异度为94.95%;女性患者立位ARR最佳切点为3.72(ng/dl)/(m U/L),敏感度为88.78%,特异度为92.79%;18~<40、40~<60和≥60岁患者立位ARR最佳切点依次为2.69、2.62和2.98(ng/dl)/(m U/L);BMI≥28.0、24.0~<28.0和18.5~<24.0 kg/m^(2)患者立位ARR最佳切点依次为2.67、2.98和2.25(ng/dl)/(m U/L)。结论 立位ARR筛查天津地区高血压人群中PA的最佳切点为2.98(ng/dl)/(m U/L),综合考虑性别、年龄、BMI影响因素将提高PA筛查诊断的准确性。Objective To explore the optimal cut-off point of plasma aldosterone concentration(PAC)/direct renin concentration(DRC)ratio(ARR)for screening primary aldosteronism(PA)among hypertensive population in Tianjin,and provide the basis for clinical screening diagnosis of PA.Methods A total of 1075 local hypertensive patients from Tianjin area who underwent PA screening in the Tianjin Medical University General Hospital from October 2021 to September 2023 were included.The clinical information and supine and upright PAC,DRC and ARR of the patients were collected.The t test,rank sum test and χ^(2) test were used to analyze the data and the used software was SPSS 22.0.The optimal cut-points for screening PA were determined by plotting the receiver operating characteristic(ROC)curve of patients,and the cut-off points of ARR in different gender,age and BMI were further analyzed.Results Among 1075 included hypertensive patients,190 cases were PA patients(17.67%)and 885 cases were essential hypertension patients(82.33%).The area under the curve(AUC)of upright ARR was 0.975(95%CI:0.966-0.984)and the optimal cut-off point was 2.98(ng/dl)/(mU/L)(sensitivity=94.86%,specificity=92.76%).The AUC of supine ARR was 0.976(95%CI:0.967-0.985)and the optimal cut-off point was 4.36(ng/dl)/(mU/L)(sensitivity=93.71%,specificity=92.06%).Stratified analysis showed that the optimal cut-off point of upright ARR was 2.72(ng/dl)/(mU/L)(sensitivity=96.74%,specificity=94.95%)in males and 3.72(ng/dl)/(mU/L)(sensitivity=88.78%,specificity=92.79%)in females.The optimal cut-off points of upright ARR in the 18-<40,40-<60 and≥60 year-old groups were 2.69,2.62 and 2.98(ng/dl)/(mU/L),respectively;and in the BMI≥28.0,24.0-<28.0 and 18.5-<24.0 kg/m 2 were 2.67,2.98 and 2.25(ng/dl)/(mU/L),respectively.Conclusion The optimal cut-off point of upright ARR for PA screening in hypertensive population in Tianjin area was 2.98(ng/dl)/(mU/L).Considering of gender,age and BMI influencing factors,the accuracy of PA screening diagnosis could be improved.

关 键 词：原发性醛固酮增多症 醛固酮与肾素比值 筛查试验 切点值 

分 类 号：R544.1[医药卫生—心血管疾病]