原发性醛固酮增多症筛查试验在老年高血压患者中的效能分析及其与中青年患者的差异  

Efficacy analysis of screening test for primary aldosteronism in the elderly patients with hypertension and its differences with young-to-middle age patients

作　　者：骆秦[1] 王梦卉[2] 努尔古丽·买买提[2] 努尔布维·吐尔逊 赵建雯 孙乐[2] 岳娜[2] 李南方[2] LUO Qin;WANG Meng-hui;NUERGURLI Mai-mai-ti;NUERBUWI Tu-er-xun;ZHAO Jian-wen;SUN Le;YUE Na;LI Nan-fang(Xinjiang Medical University,Urumqi Xinjiang 830054)

机构地区：[1]新疆医科大学,新疆乌鲁木齐830054 [2]新疆维吾尔自治区人民医院高血压诊疗中心,新疆高血压研究所

出　　处：《中华高血压杂志》2019年第9期867-873,共7页Chinese Journal of Hypertension

基　　金：国家自然科学基金地区科学基金项目(81660139);中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助(2019PT330003)

摘　　要：目的本研究旨在分析原发性醛固酮增多症(PA)的筛查试验——醛固酮与肾素活性比值(ARR)在老年高血压患者中的效能及其与中青年高血压患者的差异。方法连续纳入在新疆自治区人民医院高血压诊疗中心住院、经过规范化PA筛查及诊断流程的高血压患者883例,其中219例诊断为PA、664例诊断为非PA;年龄20~79岁,按照我国老年人的年龄划分标准,将研究对象划分为老年(≥60岁,n=76)及中青年(20~59岁,n=807)。分析比较肾素活性(PRA)、血浆醛固酮浓度(PAC)及ARR等PA筛查指标在两组高血压患者中的变化趋势及筛查效能。结果(1)与中青年高血压患者相比,老年高血压患者的PRA更低[0.44(0.23~0.96)比0.85(0.36~1.91)μg/(L·h)],ARR{25.0(10.7~49.8)比14.7(7.4~36.5)(ng/dL)/[μg/(L·h)]}、ARR阳性率(60.5%比39.0%)、假阳性率更高(28.9%比14.9%),均P<0.01;两组间PA的检出率差异无统计学意义。(2)在非PA组中,PRA、PAC与年龄呈负相关(分别rs=-0.31,-0.13,均P<0.01),ARR与年龄呈正相关(rs=0.28,P<0.001);老年高血压患者的PRA水平明显低于中青年患者[0.60(0.27~1.48)比1.25(0.58~2.34)μg/(L·h),P<0.01],ARR明显高于中青年患者{15.7(8.0~31.0)比10.7(6.2~17.5)(ng/dL)/[μg/(L·h)],P<0.01}。而在PA组中,上述指标在老年及中青年高血压患者差异无统计学意义。(3)ARR在老年高血压患者中筛查PA的曲线下面积(AUC)低于中青年患者(0.878比0.952),ARR在老年高血压患者的最佳筛查切点为25.0(ng/dL)/[μg/(L·h)],敏感度为95.8%,特异度为71.2%,约登指数为0.670;而在中青年高血压患者中的最佳切点仍为20.0 (ng/dL)/[μg/(L·h)],敏感度为100%,特异度为81.0%,约登指数为0.810。(4)中青年患者中,ARR筛查PA的AUC明显高于PAC(0.952比0.846,P<0.001),其与PAC联合时效能更佳(AUC=0.967,P<0.001);老年高血压患者中,ARR单独筛查PA的AUC与PAC相比差异无统计学意义,联合PAC诊断PA的效能增加,但差异无统计学意义(AUC=0.903,P=0.07)�Objective To analyze the efficacy of screening test-aldosterone/renin ratio(ARR)for primary aldosteronism(PA)among elderly patients with hypertension and the difference between elderly and young-to-middle age patients.Methods The study included 883 hypertensive patients who were consecutively hospitalized and definitively diagnosed in hypertension treatment center of Xinjiang Uygur Autonomous Region People’s Hospital under a strict screening and diagnosis process for PA,including 219 PA patients and 664 non-PA patients.Subjects were divided into elderly(≥60 years,n=76)and young-to-middle age group(20-59 years,n=807).The trends and screening efficacy of plasma renin activity(PRA),plasma aldosterone concentration(PAC)and ARR,as screening indicators of PA,between the two groups were analyzed and compared.Results Compared with young-to-middle age patients,elderly patients had lower PRA[0.44(0.23-0.96)vs 0.85(0.36-1.91)μg/(L·h)],higher ARR{25.0(10.7-49.8)vs 14.7(7.4-36.5)(ng/dL)/[μg/(L·h)]},higher positive rate of ARR(60.5%vs 39.0%)and higher false positive rate(28.9%vs 14.9%),all P<0.01.There was no significant difference in prevalence of PA between elderly and young-to-middle age groups.In non-PA patients,PRA and PAC were negatively correlated with age(rs=-0.31 and-0.13,both P<0.01,respectively),and ARR was positively correlated with age(r=0.28,P<0.001).The PRA level of elderly patients was significantly lower than that of young-to-middle age patients[0.60(0.27-1.48)vs 1.25(0.58-2.34)μg/(L·h),P<0.01],and the ARR was significantly higher than that of young-to-middle age patients{15.7(8.0-31.0)vs 10.7(6.1-17.5)(ng/dL)/[μg/(L·h)],P<0.01}.However,the above differences between elderly and young-to-middle age patients were not obvious in PA patients.The area under the ROC curve(AUC)of ARR for screening PA in the elderly was lower than that in young-to-middle age patients(0.878 vs 0.952).The optimal cutoff value of ARR in elderly patients was 25.0(ng/dL)/[μg/(L·h)],the sensitivity was 95.8%,the specificity wa

关 键 词：原发性醛固酮增多症 醛固酮与肾素的比值 筛查试验 老年 

分 类 号：R544.1[医药卫生—心血管疾病]