| 原发性醛固酮增多症诊断性试验在醛固酮瘤诊断中的临床应用与评价 |
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| 引用本文： | 胡枫湫,黄 娟,黄 慧. 原发性醛固酮增多症诊断性试验在醛固酮瘤诊断中的临床应用与评价[J]. 四川大学学报(医学版), 2018, 49(3): 469-473 |
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| 作者姓名： | 胡枫湫 黄 娟 黄 慧 |
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| 作者单位： | 1.四川大学华西医院 内分泌代谢科 |
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| 摘 要： | 目的 评价原发性醛固酮增多症的诊断性试验的临床应用价值，探讨临床诊断醛固酮瘤的最佳指标及其切点值。方法 回顾性收集167例高血压患者的临床资料，分为醛固酮瘤组（93例）、原发性高血压组（74例），并比较两组间临床特征的差异。对卧位醛固酮，盐水负荷试验、卡托普利试验后醛固酮绝对值和下降率5项指标进行受试者工作特征（ROC）曲线绘制并比较其曲线下面积（AUC）。结果 与原发性高血压组比较，醛固酮瘤组卧位醛固酮水平更高，高血压3级患者的比例更高，血钾均值更低，体位改变和盐水负荷后醛固酮变化率更小（P<0.05）。卡托普利试验后醛固酮下降率两组间差异无统计学意义。于167例高血压患者中诊断醛固酮瘤，卧位醛固酮的AUC为0.975，盐水负荷试验后醛固酮绝对值和下降率的AUC为0.984和 0.680（P<0.001），卡托普利试验后醛固酮绝对值和下降率的AUC为0.949和0.538（P<0.001）。以卧位醛固酮/肾素比值（ARR）>30且卧位醛固酮>17.8 ng/dL为初筛阳性条件时，敏感性96.8%，特异性90.5%。以14.59 ng/dL为盐水负荷试验后醛固酮切点值时，诊断醛固酮瘤的敏感性为90.2%、特异性为97.3%。以19.11 ng/dL为卡托普利试验后醛固酮切点值时，敏感性为88.8%、特异性为95.9%。结论 以卧位ARR>30加卧位醛固酮>17.8 ng/dL为初筛阳性条件，具有较高的敏感性和特异性。盐水负荷和卡托普利试验后醛固酮水平绝对值是确诊醛固酮瘤更合理有效的指标。
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| 关 键 词： | 新型隐球菌性脑膜炎 艾滋病相关机会性感染 HIV感染 |
Efficacy of Screening and Confirmatory Tests of Primary Aldosteronism in Diagnosing AldosteroneProducing Adenoma |
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| HU Feng-qiu,HUANG Juan,HUANG Hui. Efficacy of Screening and Confirmatory Tests of Primary Aldosteronism in Diagnosing AldosteroneProducing Adenoma[J]. Journal of Sichuan University. Medical science edition, 2018, 49(3): 469-473 |
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| Authors: | HU Feng-qiu HUANG Juan HUANG Hui |
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| Abstract: | Objective To assess the efficacy of screening and confirmatory tests of primary aldosteronism (PA) in diagnosing aldosterone producing adenoma (APA). Methods Clinical data of 167 hypertensive patients were retrospectively reviewed, including 93 patients with APA and 74 patients with essential hypertension (EH). The area under curves (AUC) of receiver operating characteristic (ROC) curves were compared among the five indicators: supine plasma aldosterone concentration (PAC), absolute PAC values and PAC drop rates post saline infusion test (SIT) and captopril challenge test (CCT). Results APA patients had higher supine PAC, higher percentage of third degree hypertension, and lower serum potassium level than EH patients (P<0.05). Compared with EH patients, APA patients had lower PAC change rates, post posture change and SIT (P<0.05), but similar post CCT (P>0.05). The AUC of supine PAC reached 0.975. Higher AUC was found in absolute PAC values post SIT compared with PAC droop rates (0.984 vs. 0.680, P<0.001). Similar results were also found with CCT (0.949 vs. 0.538, P<0.001). A cut-off of supine aldosterone renin ratio (ARR) >30 and supine PAC>17.8 ng/dL had 96.8% sensitivity and 90.5% specificity. A cut-off of 14.59 ng/dL PAC post SIT had 90.2% sensitivity and 97.3% specificity. A cut-off of 19.11 ng/dL PAC post CCT had 88.8% sensitivity and 95.9% specificity. Conclusion Screening tests using supine ARR>30 plus supine PAC>17.83 ng/dL are preferred with high sensitivity and specificity. The absolute values of PAC post SIT and CCT are recommended for confirming APA. |
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| Keywords: | Primary aldosteronism Aldosterone producing adenoma Captopril challenge test Saline infusion test Hypertension |
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