血浆醛固酮/肾素浓度比值诊断原发性醛固酮增多症的价值

目的探讨血浆醛固酮/肾素浓度比值(ADRR)对原发性醛固酮增多症(PA)的诊断价值及最佳临界值。方法选取高血压患者222例,其中PA临床确诊患者33例(CPA组)。采用化学发光法检测血浆醛固酮及肾素浓度,并计算ADRR。采用受试者工作特征(ROC)曲线评价ADRR对PA的诊断价值,并确定最佳临界值。结果高血压患者中PA患者的比例为14.86%(33/222)。PA组卧位和立位的血浆肾素浓度均明显低于高血压组(P0.05),ADRR则明显高于高血压组(P0.05)。ROC曲线分析显示,血浆ADRR诊断PA卧位和立位的曲线下面积(AUC)分别为0.906和0.908;ADRR卧位的最佳临界值为31.32,敏感性和特异性分别为96.97%和73.54%;立位的最佳临界值为27.57,敏感性和特异性分别为81.82%和86.77%。结论血浆ADRR是筛查PA的有效指标。建议在PA初筛时采用25作为立位ADRR筛查的最佳临界值。     

ARR对醛固酮瘤的诊断价值

醛固酮瘤(APA)是原发性醛固酮增多症(又被称为原醛症)的一种重要亚型,约三分之一的原醛症均由APA所引起。有报道[1]指出,受醛固酮持续、大量分泌的影响,APA患者在卒中、左心室肥厚、慢性肾脏疾病等的发生率上,明显高于原发性高血压,且APA患者经手术施治,多可治愈。所以,在高血压患者中发现APA意义重大。现阶段,在筛查原醛症方面,多将血浆醛固酮浓度(PAC)与肾素活性(PRA)的比值(即ARR)当作基础指标,但有文献[2]指出,ARR有着不同的切点,统一标准缺乏。本文就醛固酮瘤中立、卧位ARR的诊断价值进行比较,现对此报道如下。     

醛固酮与肾素活性比值对原发性醛固酮增多症的诊断价值

目的 评价醛固酮与肾素活性比值(ALD/PRA,ARR)对原发性醛固酮增多症(PA)的诊断价值.方法 回顾性收集44例PA、9例嗜铬细胞瘤、8例无功能性瘤、12例库欣综合征、4例肾动脉狭窄及13例原发性高血压患者的ALD、PRA结果,计算ARR,采用受试者操作特性(ROC)曲线评价各项指标的诊断价值.结果 卧位ALD ROC曲线下面积为0.947,临界值(cut-off值)为174.1 ng/L时,敏感度为86.4%,特异度为91.3%.立位ALDROC曲线下面积为0.889,cut-off值为209.8 ng/L时,敏感度为84.1%,特异度为87.0%.卧位ARR ROC曲线下面积为0.978,cut-off值为40.8 ng·dl-1/ng·ml-1·h-1时,敏感度为95.5%,特异度为95.7%;立位ARR ROC曲线下面积为0.981,cut-off值为35.26 ng·dl-1/ng·ml-1·h-1时,敏感度为95.5%,特异度为93.5%;联合立位ARR和立位ALD,其诊断价值明显优于单一指标,当立位ALD>275 ng/L,立位ARR ROC曲线下面积为0.989,cut-off值为23.73 ng·dl-1/ng·ml-1·h-1时,特异度为100%,敏感度为95.7%.结论 ARR诊断PA的价值高于ALD、PRA,立位ARR优于卧位,当联合立位AID>275ng/L,则诊断价值更大.     

血浆醛固酮浓度/血浆肾素活性比值对原发性醛固酮增多症的诊断价值

目的探讨血浆醛固酮浓度/血浆肾素活性比值(ARR)对原发性醛固酮增多症的鉴别诊断价值。方法随机选取2017年1月至2018年12月85例原发性醛固酮增多症患者作为研究组,另选取我院同期收治的85例原发性高血压患者作为对照组,两组患者均予以血浆醛固酮浓度、血浆肾素活性检测,记录两组上述指标检测结果、计算各组血浆醛固酮浓度/血浆肾素活性比值。结果研究组血浆醛固酮浓度、血浆醛固酮浓度/血浆肾素活性比值显著高于对照组,研究组血浆肾素活性显著低于对照组,差异有统计学意义(P0.05)。结论应用血浆醛固酮浓度/血浆肾素活性比值可为鉴别诊断原发性醛固酮增多症、原发性高血压提供有力依据,提高原发性醛固酮增多症诊断准确率。     

血浆ARR筛查原发性醛固酮增多症的应用分析

目的探讨血浆醛固酮/肾素活性比值(ARR)在原发性醛固酮增多症(PA)的应用分析。方法选取2016年1月至2017年12月在驻马店市中心医院治疗的PA患者78例(PA组),同时选取疑似PA但确诊为原发性高血压(EH)患者120例(EH组),比较两组临床一般资料以及卧位、立位ARR水平。方法 PA组收缩压、舒张压和尿钾分别为(162.20±20.03)mmHg、(103.20±12.23)mmHg和(37.18±9.39)mmol/L,明显高于EH组(P0.05),而血钾为(3.02±0.55)mmol/L,明显低于EH组(P0.05);PA组卧位、立位ARR分别为73.01(42.23,120.03)ng·dl-1/ng·ml-1·h-1和60.10(30.12,220.43)ng·dl-1/ng·ml-1·h-1,明显高于EH组(P0.05);卧位ARR和立位ARR诊断PA的ROC曲线下面积分别为0.910和0.946(P0.05),卧位ARR和立位ARR截断值分别为15.96ng·dl-1/ng·ml-1·h-1和32.96ng·dl-1/ng·ml-1·h-1,灵敏度分别为94.90%和100.00%,特异度分别为80.83%和81.67%。结论血浆ARR筛查PA有重要作用,其中立位ARR筛查诊断的价值可能较高,值得进一步研究。     

原发性醛固酮增多症的临床特点

目的了解原发性醛固酮增多症(原醛症)的常见症状和早期症状,比较病理为肾上腺皮质腺瘤和增生的原醛症的临床表现的不同.方法回顾性调查原醛症患者的临床资料,选择标准为血浆醛固酮水平增高和手术病理证实为肾上腺皮质腺瘤或皮质增生的患者共90例.结果原醛症患者临床常见症状依次为高血压(100%)、口渴多尿(26.6%)、四肢乏力(23.3%)、四肢麻木(15.5%)、四肢抽搐(4.4%);早期表现为高血压,高血压至确诊时病程为(5±7)年,最高血压为(191±25)/(116±15) mm Hg,平均血压为(154±16)/(97±10) mm Hg,左心室肥厚的频率为43.5%;94.4%的患者存在低血钾;低肾素活性血症卧位发生率70.3%,立位发生率为94.3%;血浆醛固酮/血浆肾素活性比值以25/1为截取点,立位及卧位的阳性率均为72.4%,以50/1为截取点,敏感性明显下降;腺瘤组平均血压明显高于增生组[(157±17)/(99±10) mm Hg )vs(148±13)/(92±10) mm Hg];低钾血症发生率在腺瘤组更易发生(98.5% vs 84.0%);腺瘤组血浆醛固酮水平亦较增生组明显增高(P<0.05).结论原醛症的患者临床上常见症状依次为高血压、口渴多尿、四肢乏力、四肢麻木、四肢抽搐等,早期表现为高血压,且往往是在高血压多年后才因出现低血钾而确诊,部分患者可无低血钾;高血压的特点为重度高血压,药物对其有一定效果,但不能达标,易发生高血压的并发症;低肾素血症和血浆醛固酮/血浆肾素活性的比值对诊断原醛症有一定意义,但也会漏掉一部分患者;在临床表现和实验室检查上肾上腺皮质腺瘤严重程度高于肾上腺皮质增生的患者.     

醛固酮腺瘤患者血浆醛固酮、肾素水平分析

目的探讨化学发光免疫法(CLIAS)检测血浆醛固酮、肾素对醛固酮腺瘤(APA)的筛查价值。方法选取确诊为APA并经手术治疗的患者79例及确诊为原发性高血压(EH)的患者96例,采用CLIAS检测所有患者血浆醛固酮、肾素水平。比较APA患者术前、术后血浆醛固酮、肾素水平及醛固酮/肾素比值(ARR)。采用受试者工作特征(ROC)曲线评价ARR诊断APA的性能。结果 APA组血浆醛固酮水平及ARR明显高于EH组(P0.05)、血浆肾素水平明显低于EH组(P0.05)。ROC曲线分析结果显示,立位ARR诊断APA的曲线下面积为0.938,最佳临界值为42.8,敏感性为98.0%,特异性为91.6%,约登指数为0.896。与术前比较,APA患者术后立位醛固酮水平明显降低(P0.05),肾素水平明显升高(P0.05),ARR明显下降(P0.001)。结论 CLIAS可作为血浆肾素、醛固酮检测的有效方法,在APA筛查中具有重要价值。     

原发性醛固酮增多症患者血清NT-proBNP改变及临床意义研究

目的探讨原发性醛固酮增多症(PA)患者血清脑利钠肽前体N末端(NT-proBNP)改变及临床意义。方法纳入2012年1月至2015年12月疑似PA的高血压患者140例,分为PA组(n=30)和原发性高血压(EH)组(n=110)。检测两组患者血清NT-proBNP和肾素水平,并通过受试者工作特征曲线(ROC曲线)分析以及相关性分析比较血清NT-proBNP水平与PA的相关性。结果 PA组患者血清NT-proBNP水平[(93.9±7.3)pg/mL]明显高于EH组患者[(69.5±10.4)pg/mL],差异有统计学意义(P0.05)。单侧亚组PA患者肾素[(6.8±1.3)pg/mL vs.(5.1±0.6)pg/mL]、血浆醛固酮/血浆肾素比值(ARR)[(65.5±16.4)vs.(57.1±14.4)]和NT-proBNP[(101.9±14.1)pg/mL vs.(90.4±8.1)pg/mL]水平明显高于双侧亚组,差异均有统计学意义(P0.05)。NT-proBNP预测PA的AUC为0.809,95%CI:0.734~0.865,cut-off为98.4pg/mL,敏感度为83.4%,特异度为78.6%。预测单侧PA的AUC为0.733,95%CI:0.648~0.804,cut-off为109.6pg/mL,敏感度为79.9%,特异度为81.5%。血清NT-proBNP水平与ARR(r=0.765,P0.05)、PA(r=0.728,P0.05)和单侧PA(r=0.778,P0.05)呈正相关。结论 PA患者相比EH患者血清NT-proBNP水平轻度升高,有助于PA患者的早期诊断和筛查。     

不同体位肾素活性变化值对原发性醛固酮增多症鉴别诊断的价值

目的评估不同体位肾素活性变化值在高血压患者中诊断原发性醛固酮增多症(PA)的效能。 方法研究对象为2010年1月至2012年12月新疆维吾尔自治区人民医院高血压科收治的307例需要行继发性高血压筛查的高血压病患者。所有患者已行常规坐位肾素、醛固酮测定及立位、坐位、卧位肾素活性(PRA)、醛固酮测定、常规生化检测及人体学测量。满足坐位醛固酮/PRA值≥554 pmol/L·[μg/ (L·h)]^－1并且盐水输注试验后醛固酮≥277 pmol/L的患者被定义为PA组,其余患者为非PA组。使用四格表计算相关指标的敏感度、特异度等。 结果PA组与非PA组立位、坐位、卧位三种体位PRA比较,PA组[0.61 μg/(L·h),0.62 μg/(L·h),0.31 μg/(L·h)]低于非PA组[1.42 μg/(L·h),1.18 μg/(L·h),0.51 μg/(L·h)],差异有统计学意义(F＝11.465,12.052,10.296;P＝0.001);PA组与非PA组体位变换后PRA差值比较,PA组立卧位PRA差值[0.24 μg/(L·h)]低于非PA组[0.78 μg/(L·h)],差异有统计学意义(F＝8.303,P＝0.004);立位后PRA<1.0 μg/(L·h)或立卧位PRA差值<0.6 μg/(L·h)单项指标诊断PA的敏感度分别为64%及70%,特异度分别为62%及68%,阴性预测值分别是91%及93%;立位后PRA<1.0 μg/(L·h),联合立卧位PRA差值<0.6 μg/(L·h)诊断PA,其敏感度为45%,特异度为88%。 结论利用体位变换后PRA的变化值诊断PA效能较低,但有排除PA的临床价值,此试验患者配合度高,为生理性刺激试验,可安全有效地鉴别PA,联合试验后相关指标对诊断PA有临床参考价值。     

以低钾周期性麻痹就诊的原发性醛固酮增多症1例

正原发性醛固酮增多症(以下简称原醛症)是由于肾上腺皮质增生或肿瘤而自主分泌过多醛固酮,临床表现为患者有高血压、钠潴留,因排钾增多而导致低钾血症。由于人们对其认识不足,常造成误诊和漏诊。原醛症过去认为是一种少见病,近年来利用血浆醛固酮与血浆肾素活性比值(ARR)从高血压人群中筛选原醛症,其发病率为5%~15%,是一种常见的继发性高血压~[1]。本科室2015年5月收治1例原醛症,表现为严     

Analytical validation and investigation on reference intervals of aldosterone and renin in Chinese Han population by using fully automated chemiluminescence immunoassays

BackgroundThe aldosterone/renin ratio (ARR) is recommended to screen for primary aldosteronism (PA) in hypertension. We estimated fully automated chemiluminescence immunoassays (CLIA) for plasma aldosterone concentrations (PAC) and plasma direct renin concentrations (PRC) and investigated their reference intervals in Chinese Han population.MethodsPAC and PRC were measured on a fully automated analyzer (LIAISON XL, DiaSorin, Italy). Performance characteristics were estimated according to CLSI approved guidelines. 328 healthy individuals were selected for reference intervals investigation. Results simultaneously tested by CLIA and radioimmunoassays were reviewed from 123 patients with hypertension and/or adrenal space-occupying lesion. PAC/PRC ratio (ARR_prc) was compared to PAC/plasma renin activity (PRA) ratio (ARR_pra).ResultsWithin-laboratory imprecision was 5.6%–6.7% for PAC and 3.0%–3.3% for PRC. The LoQ was 72.2 pmol/L for PAC and 1.27 mIU/L for PRC. Linearity was excellent in the range of concentrations between 94 and 2708 pmol/L for PAC and 1.3–461.8 mIU/L for PRC. Interferences of hemoglobin, unconjugated bilirubin and lipaemia could be acceptable, but not of conjugated-bilirubin when renin and aldosterone at low concentrations. The central 95% reference intervals for males: PAC: 76–722 pmol/L, PRC: 3.3–92.7 mIU/L, ARR: 2.2–46.0 pmol/mIU; for females: PAC: 85–1010 pmol/L, PRC: 3.7–99.8 mIU/L, ARR: 3.6–68.4 pmol/mIU. Upper reference limits for ARR of younger and older men were lower than women. ARR_prc and ARR_pra showed almost perfect agreement (kappa = 0.815) for screening PA.ConclusionThe DiaSorin tests are valuable analytical options for PAC and PRC measurements. We recommend sex-specific and age-specific reference intervals of these items should be estimated.     

液相色谱串联质谱法对原发性醛固酮增多症的诊断价值

目的： 探讨液相色谱串联质谱（LC-MS/MS）检测方法中的卡托普利试验（captopril test，CCT）和生理盐水输注试验（saline infusion test，SIT）对原发性醛固酮增多症（primary aldosteronism，PA）的诊断价值。方法： 选取2018年2月至2019年2月复旦大学附属中山医院内分泌科收治的高血压患者127例，其中111例患者行CCT试验，101例患者行SIT试验。通过LC-MS/MS方法检测患者试验前后血浆醛固酮浓度（PAC）、肾素活性及醛固酮/肾素活性比值（aldosterone/renin ratio，ARR）水平。以手术或螺内酯试验为诊断金标准，采用CCT和SIT的ROC曲线探讨2种试验的诊断指标和最佳诊断截断值。结果： PA患者57例，原发性高血压患者70例。CCT后醛固酮、ARR及醛固酮抑制率的AUC分别为0.876、0.902和0.751；ARR为6.5时，诊断PA的灵敏度为94.2%，特异度为78%；PAC为34.8 pg/mL时，诊断PA的灵敏度为75.5%，特异度为93.2%。SIT后醛固酮、ARR及醛固酮抑制率的AUC分别为0.881、0.823和0.652；PAC为24 pg/mL时，诊断PA的灵敏度为87.2%，特异度为78.8%。结论： CCT后ARR和PAC均可作为PA的诊断指标，诊断截断值为6.5和34.8 pg/mL；SIT试验后PAC为PA诊断指标，诊断截断值为24 pg/mL。     

Comparison of immunoreactive renin and plasma renin activity in human plasma

Measurement of immunoreactive plasma renin concentration (PRC) using direct radioimmunoassay (RIA) was compared with the common procedure, measurement of plasma renin activity (PRA). The sensitivity of the PRC assay was 5 pg/ml. In 67 normal subjects aged 45.2 +/- 1.2 year, the mean PRC value was 17.0 +/- 0.9 pg/ml in the recumbent position and 38.0 +/- 5.4 pg/ml in the upright position. In patients with high renin essential hypertension and renovascular hypertension, discrepancies were observed between changes in PRA and PRC at 60 min after the administration of captopril. In a patient with Bartter's syndrome PRC was markedly elevated (393 pg/ml) and the changes in PRA and in PRC after captopril were very different (452% vs. 1249%). In all 10 cases of primary hyperaldosteronism PRC was less than 5 pg/ml. The correlation coefficient between PRC and PRA was 0.85 (n = 227, p less than 0.01). The slope of the regression line between PRA and PRC decreased in proportion to PRC values. Direct RIA for PRC is likely to be useful for the determination of plasma active renin when renin levels are high or substrate concentrations are abnormal. Moreover, the combined use of PRA and PRC measurements might be useful in assessing abnormalities in renin substrate concentration as well as in PRC.     

经手术病理证实的原发性醛固酮增多症102例临床分析

目的在经手术病理证实的原发性醛固酮增多症(PA)患者中评价术前各项诊断筛查方法的临床价值。方法回顾性分析经手术病理证实的102例PA患者的临床特征、生化资料及血浆醛固酮浓度(PAC)、血浆醛固酮与肾素比值(ARR),比较不同指标筛查PA的阳性率,不同试验对PA的确诊率及影像学检查对PA的检出率和诊断符合率。结果在上述患者中:(1)ARR>20 ng/dl·(ng·ml-1·h-1)-1筛查PA的阳性率为86.27%;ARR>20 ng/dl·(ng·ml-1·h-1)-1且PAC>15 ng/dl筛查PA的阳性率为68.63%(P<0.01)。(2)静脉盐水抑制试验和卡托普利抑制试验对PA的确诊率分别为100%和80%(P>0.05)。(3)影像学检查中,CT和MRI对PA的检出率明显高于超声(P<0.01);与术后病理对照,CT对醛固酮腺瘤(APA)和单侧肾上腺皮质增生(UAH)的诊断符合率分别为97.33%和78.26%(P<0.01),MRI对APA和UAH诊断符合率分别为88.89%和75.00%(P>0.05)。结论 ARR>20 ng/dl·(ng·ml-1·h-1)-1筛查PA的阳性率高于ARR>20 ng/dl·(ng·ml-1·h-1)-1联合PAC>15 ng/dl;盐水抑制试验和卡托普利抑制试验都有较高的确诊率;影像学检查中,CT对PA有较高的检出率和诊断符合率,对于分型而言,CT对APA的诊断符合率高于UAH。     

Rapid screening test for primary hyperaldosteronism: ratio of plasma aldosterone to renin concentration determined by fully automated chemiluminescence immunoassays

BACKGROUND: The ratio of plasma aldosterone concentration to plasma renin activity (PAC/PRA) is the most common screening test for primary hyperaldosteronism (PHA), but it is not standardized among laboratories. We evaluated new automated assays for the simultaneous measurement of PAC and plasma renin concentration (PRC). METHODS: We studied 76 healthy normotensive volunteers and 28 patients with confirmed PHA. PAC and PRC were measured immunochemically in EDTA plasma on the Nichols Advantage chemiluminescence analyzer, and PRA was determined by an activity assay. RESULTS: In volunteers, PAC varied from 33.3 to 1930 pmol/L, PRA from 1.13 to 19.7 ng.mL(-1).h(-1) (0.215 ng.mL(-1).h(-1) = 1 pmol.L(-1).s(-1)), and PRC from 5.70 to 116 mU/L. PAC/PRA ratios ranged from 4.35 to 494 (pmol/L)/(ng.mL(-1).h(-1)) and PAC/PRC ratios from 0.69 to 71.0 pmol/mU. In PHA patients, PAC ranged from 158 to 5012 pmol/L, PRA from 0.40 to 1.70 ng.mL(-1).h(-1), and PRC from 0.80 to 11.7 mU/L. PAC/PRA ratios were between 298 and 6756 (pmol/L)/(ng.mL(-1).h(-1)) and PAC/PRC ratios between 105 and 2328 pmol/mU. Whereas PAC or PRC showed broad overlap between PHA patients and volunteers, the PAC/PRC ratio indicated distinct discrimination of these two groups at a cutoff of 71 pmol/mU. CONCLUSION: The PAC/PRC ratio offers several practical advantages compared with the PAC/PRA screening method. The present study offers preliminary evidence that it may be a useful screening test for PHA. Further studies are required to validate these results, especially in hypertensive cohorts.     

Validity of the aldosterone-renin ratio used to screen for primary aldosteronism

OBJECTIVE: To determine whether the calculated ratio of plasma aldosterone concentration (PAC) to plasma renin activity (PRA), a proposed screening test for primary aldosteronism, provides a renin-independent measure of circulating aldosterone that is suitable to judge whether PAC is inappropriately elevated relative to PRA. SUBJECTS AND METHODS: This study consisting of 221 black and 276 white subjects with previously diagnosed essential hypertension was conducted between 1996 and 2000. Antihypertensive drugs were withdrawn for at least 4 weeks; PAC and PRA were measured while subjects were supine and then seated after 30 minutes of ambulation. The seated measurements were repeated after 4 weeks of oral diuretic therapy with hydrochlorothiazide (25 mg/d). RESULTS: The variation in the aldosterone-renin ratio was strongly and inversely dependent on PRA (R2=0.71; P<.001). When subjects changed position from supine to seated, the increase in mean +/- SD PRA (from 1.18 +/- 1.06 to 1.31 +/- 1.19 ng x mL(-1) x h(-1); P<.001) was associated with an increase in the mean ratio (from 18.6 +/- 52.8 to 25.8 +/- 38.1 h x 10(2); P<.001), whereas the increase in mean +/- SD PRA in response to diuretic therapy (from 1.31 +/- 1.19 to 2.72 +/- 2.67 ng x mL(-1) x h(-1); P=.007) was associated with a decrease in the mean ratio (from 25.8 +/- 38.1 to 16.4 +/- 31.6 h 10(2); P<.001). CONCLUSION: In patients with previously diagnosed essential hypertension, calculation of the aldosterone-renin ratio does not provide a renin-independent measure of circulating aldosterone that is suitable for determining whether PAC is elevated relative to PRA. Because elevation of the aldosterone-renin ratio is predominantly an indicator of low PRA, its perceived value in screening for primary aldosteronism most likely derives from additional diagnostic tests being done in patients with low-renin hypertension.     

Responsiveness of the renin-aldosterone system during exercise in young patients with essential hypertension

Abstract. The effect of exercise of gradually increased intensity, i.e. 75 W for 20 min followed by 100 W for 20 min, on plasma renin concentration (PRC) and plasma aldosterone concentration (PAC) was studied in young patients with essential hypertension and normotensive control subjects. During exercise without previous sodium loading PRC and PAC increased to the same degree in both hypertensives and normotensives during light exercise; PRC increased further significantly in the normotensives (63 to 72 μIU/ml (medians), P < 001) but not in the hypertensives (46 to 51 μIU/ml) during heavy exercise. PRC and PAC were significantly correlated during both 75 W (p = 0–633, P<005) and 100 W (p = 0–635, P<005) exercise in the normotensives, but not in the hypertensives. During exercise after loading with 500 ml sodium chloride (0–85 mol/1) PRC and PAC increased in both hypertensives (28 to 42 μIU/ml, P< 0.01; 0.11 to 0.53 nmol/1, P < 001) and normotensives (22 to 33 μIU/ml, P<002; 012 to 0–34 nmol/1, P<00), although to a considerably lower degree than without previous loading. PRC and PAC were, however, significantly higher in the hypertensive than in the normotensive group after exercise. It is suggested that the responsiveness of the renin-aldosterone system is abnormal during exercise in young patients with mild essential hypertension, both without and with previous intravenous sodium loading.     

高血压鉴别诊断性实验的研究分析

目的 探讨生理盐水滴注抑制试验、卡托普利抑制试验诊断原发性醛固酮增多症的临床意义及护理措施。方法 收集2012年1～7月在我科治疗的56例高血压患者的临床资料,行生理盐水滴注抑制试验和卡托普利抑制试验诊断高血压原因,比较确诊病例与疑似病例的血浆醛固酮、肾素、醛固酮/肾素活性比值。结果 10例原发性高血压,46例继发性高血压,其中确诊原发性醛固酮增多症18例,疑似病例28例,两组的性别、年龄、收缩压及舒张压比较差异无显著意义（P〉0.05）,具有可比性。两组血浆醛固酮的平均值分别为30.8ng/L、12.9ng/L,肾素0.26ng/（ml·h）、0.54ng/（ml·h）,醛固酮/肾素活性比值150.1、23.2,差异有显著意义（P〈0.001）。结论 生理盐水滴注抑制试验和卡托普利抑制试验是筛选、确诊原发性醛固酮增多症的主要手段,护理是准确地进行试验的关键,试验前仔细准备,试验中严格用药、病情观察、准确采集标本,试验后观察及记录检查结果非常重要。