不同体位检测肾素和醛固酮在诊断原发性醛固酮增多症中的应用价值

目的 探讨在不同体位下检测患者的血浆肾素活性（plasma renin activity，PRA）、血浆醛固酮浓度（plasma aldosterone concentration，PAC）和醛固酮/肾素比值（aldosterone/renin ratio，ARR）在诊断原发性醛固酮增多症（primary aldosteronism，PA）中的应用价值。方法 选择被笔者医院怀疑为PA的患者216例，采用放射免疫法对其行立位、坐位、卧位检测血浆PRA和PAC，计算ARR，以静脉盐水负荷试验诊断结果为标准，绘制ROC曲线，分析各体位检测PRA、PAC及ARR在诊断PA中的应用价值。结果 PA组患者的血钾水平与非PA组比较（P<0.05），其他临床资料组间比较（P>0.05）；不同体位检测下的PRA值和PAC值PA组与非PA组比较差异有统计学意义（P<0.05或P<0.01），PA组、非PA组患者不同体位检测PRA值和PAC值组内比较差异有统计学意义（P<0.01）；不同体位下PRA、PAC、ARR的AUC均>0.5，其中卧位PAC的AUC为0.823，AUC 95% CI为0.743~0.903。结论 卧位PAC在诊断PA中准确性较高，对怀疑为PA且不宜进行静脉盐水负荷试验的患者，行卧位检测PAC是一种不错选择。

Application Value of Primary Aldosterone Diagnosis by Detection of Renin and Aldosterone in Different Positions

Objective To explore the Application value of primary aldosterone diagnosis by detection of plasma renin activity(PRA), plasma aldosterone concentration(PAC) and aldosterone/renin ratio(ARR) in different positions. Methods 216 patients suspected of PA from our hospital were selected, Radioimmunoassay were used to test PRA and PAC in standing, sitting and supine position, ARR were calculated, diagnostic results of intravenous saline load test were used as standard, draw ROC curve, analyze the application value of PRA, PAC and ARR in PA diagnosis. Results The serum potassium level between PA group and Non PA group(P<0.05),comparison among other clinical data(P>0.05).The PRA value and PAC value in different positions between PA group and Non PA group had significant difference(P<0.05 or P<0.01).The PRA value and PAC value in different positions of PA group and Non PA group had significant difference(P<0.01). The AUC of PRA, PAC and ARR in different positions were greater than 0.5, and the AUC of PAC in lying position is 0.823,AUC 95%CI were 0.743-0.903. Conclusion The PAC in lying position is more accurate in PA diagnose, PA diagnose in lying position is good for patient who are suspected PA and not suitable for intravenous saline load test.