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)诊断中的临床价值

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)诊断中的临床价值.方法 选择我院2013年1月~2015年1月收治的高血压疑似PA的患者250例,收集所有患者的基本资料,对患者进行原发性醛固酮增多症的筛查,患者采取卧位或者立位,检查指标包括血浆醛固酮(PAC)、血浆肾素(PRA)等,经确诊分为PA组100例和EH(原发性高血压)组150例,对比两组基本资料情况和不同体位的血浆醛固酮活性比值、血浆醛固酮、血浆肾素水平.结果 ①与EH组对比,PA组年龄明显更小,高血压病程明显更长,舒张压和收缩压明显更高,血钾水平明显更低,尿钾含量明显更高,P<0.05;两组患者的性别比较差异不具有统计学意义,P>0.05.②与EH组对比,PA组卧位和立位PAC明显更高,卧位和立位PRA明显更低,卧位和立位ARR明显更高,P<0.05.结论 血浆醛固酮肾素活性比值(ARR)在原发性醛固酮增多症(PA)诊断中具有较高的准确度,可作为可靠的筛查指标,值得临床广泛应用.     

原发性醛固酮增多症患病率调查

目的在高血压人群中进行原发性醛固酮增多症（原醛症）患病率的筛查。方法抽取就诊患者立位2d,时静脉血查血浆醛固酮与血浆。肾素之比（ARR）,若ARR大于30,进一步行肾上腺CT检查或卡托普利试验,以确定原醛症的诊断。结果817例患者中,诊断为原醛症的31例,占3．8％,伴有低钾者占65％,血钾正常者占35％。结论ARR是针对高血压人群进行原醛症筛查的有效指标,可提高原醛症的检出率,我国原醛症患者仍以低钾占多数。     

不同体位醛固酮/肾素比值对鉴别诊断原发性醛固酮增多症的意义

目的:研究不同体位醛固酮/肾素比值(ARR)对鉴别诊断原发性醛固酮增多症(PA)的两个主要亚型肾上腺皮质醛固酮瘤(APA)和特发性醛固酮增多症(IHA)的意义。方法:在40例临床确诊的PA患者中进行卧立位试验。结果:①IHA组立位醛固酮较卧位明显升高(P<0.05)②APA组立位较IHA组醛固酮及肾素都显著升高(P<0.05)③立位ARR≥100结合立位血浆醛固酮水平>200ng/dL鉴别APA及IHA敏感性和特异性分别为77.27%和78.26%。结论:立位ARR结合立位血醛固酮水平在APA及IHA鉴别诊断中价值有限。     

联合检测醛固酮肾素活性比值与血钾在早期诊断原发性醛固酮增多症中的意义

目的探讨血钾联合卧位醛固酮/血醛固酮比值(ARR)在高血压患者早期筛选原发性醛固酮增多症中的诊断价值,提高原醛的诊治水平。方法回顾分析并收集55例(经病理证实)原发性醛固酮增多症患者的临床资料,包括血钾水平、卧位血醛固酮(SAC),卧位血浆肾素活性(PRA),并计算卧位ARR(醛固酮/肾素活性),并设立50例高血压患者为对照组,测定各指标的灵敏度、特异度、准确度。结果卧位ARR若以113.2作为临界值,如果卧位ARR大于113.2,诊断PA的灵敏度为96.36%(53/55),特异性为98%(49/50),准确性为98.15%(53/54);血钾若以2.75作为临界值,如果血钾<2.75,诊断PA的灵敏度为92.73%(51/55),特异性为92%(46/50),准确性为92.73%(51/55);联合卧位ARR与血钾的临界值,即卧位ARR>113.2与血钾<2.75,诊断PA的灵敏度为92.73%,特异度为90%,准确度为100%。结论卧位ARR、血钾对PA有较好的诊断价值,联合检测醛固酮肾素活性比值与血钾早期诊断原醛的准确度更高,即当ARR>113.2,血钾<2.75时,确诊原醛的准确率为100%,推荐联合检测醛固酮肾素活性比值与血钾作为早期诊断原醛的指标。     

原发性醛固酮增多症高血压的临床特点分析

目的：通过临床观察探讨原发性醛固酮增多症高血压患者的临床主要特征。方法原发性醛固酮增多症高血压患者31例作为观察组,并以同期接收的35例原发性高血压患者作为对照组。两组患者均开展临床相关检测,通过结果比较分析观察组患者的临床特征。结果两组患者的基本情况比较差异无统计学意义（P〉0.05）,但观察组血压水平略高于对照组;观察组患者在卧位与站立位下肾素活性（PRA）、血醛固酮（PAC）以及醛固酮-肾素比值（ARR）水平与对照组比较,差异均具有统计学意义（P〈0.05）。结论原发性醛固酮增多症高血压患者具有PRA、PAC与ARR水平异常等临床特征,经上述指标检验可避免诊断误区,提高准确程度。     

轮状病毒疫苗对防治小儿轮状病毒性肠炎的临床观察

报告我院自1998-1999年间共收治原发性醛固酮症20例,其中腺瘤16例（80%）,增长4例（20%）,肿瘤直径1cm-2.8cm,20例均有低血钾（2.0-3.2mmd/L,20例24小时尿醛固酮测定,16例17.5-92.6ug,明显高于正常值,15例血浆肾素活性测定均低于正常,13例血醛固酮测定高于正常,18例行要使舒道试验,14例血钾恢复正常,血钾排出减少,定位诊断CT,B超检查率较高。结果：腺瘤16例症状消失,血钾正常,14例血压恢复正常,增长4例部分症状消失,血钾正常2例,2例血压降至正常,对原发性醛固酮症诊断、手术途径及增长治疗进行了讨论。     

分段血浆醛固酮/肾素活性比值对原发性醛固酮增多症的诊断效力

目的:探讨血浆醛固酮/肾素比值(ARR)对原发性醛固酮增多症(PA)的诊断效力.方法:收集我院经术后病理确诊的279例原发性醛固酮增多症(PA)患者及同期随机抽取的70例原发性高血压(PH)患者,计算血浆ARR,以10为组距,分为11组,计算各个组段的PA和PH例数及ARR值诊断PA的敏感度、特异度和Youden指数,并绘制ROC曲线.结果:ARR在30～、40～、50～各组段内,诊断PA的敏感度、特异度及Youdon指数分别为83.2％、82.9％、66.1％,77.8％、88.6％、66.4％和74.2％、92.9％、67.1％.结论:ARR在30～60之间时诊断PA的敏感度、特异度及Youden指数较高.     

酷似多发性肌炎的原发性醛固酮增多症5例临床分析

目的加深对以严重骨骼肌损伤（肌痛肌无力、肌酶增高）为首发或突出表现的原发性醛固酮增多症（PA）的认识，提高早期诊断水平，减少误诊率。方法总结5例以严重骨骼肌损伤为首发或突出表现的PA患者的临床、实验室、影像学、病理资料及治疗、预后情况，并进行文献复习。结果5例患者的临床特点、肌电图和（或）肌肉病理符合或基本符合多发性肌炎（PM）的诊断标准，同时存在高血压、低血钾、高尿钾、碱血症，肾上腺CT及手术病理证实为肾上腺腺瘤，确诊为PA。均经手术切除腺瘤，肌痛肌无力很快缓解，血钾、血清肌酸激酶（CK）、血压恢复正常。随诊4个月至5年均无复发迹象。结论诊断PM应慎重，若临床上出现该病无法解释的其他情况，应积极查找原因。     

原发性醛固酮增多症106例患者回顾性分析

<正>原发性醛固酮增多症(primary aldosteronism,PA)指肾上腺腺瘤、肾上腺皮质增生等几种病理改变所造成的高血压伴有低钾血症、低血浆肾素活性和高血浆醛固酮水平。是继发性高血压的常见病因。该病多见于成年人。在高血压中发病率为3%～32%,平均为高血压患者的10%[1],也     

糖代谢异常患者血浆醛固酮水平变化的临床意义

目的观察高血糖、高血压患者中肾素-血管紧张素蹙固酮（renin-angiotensin-aldosterone,RAA）水平,探讨是否RAAS的激活是2者共同的发病机制。方法用放射免疫分析法测定106例正常人、112例单纯糖代谢异常患者、101例单纯原发性高血压患者及127例糖代谢异常合并原发性高血压患者的血浆RAA水平和活性。结果3组醛固酮水平均明显高于CON组,差异有统计学意义（P〈0．01）,I-IGM常组中血管紧张素Ⅱ水平明显高于其他各组,差异有统计学意义（P〈0．01）,各组间肾素活性差异无统计学意义。血浆醛固酮水平与空腹血糖、肾素、收缩压、血管紧张素Ⅱ高度相关。结论高血糖和原发性高血压同样存在RAAS的激活,组织水平干预醛固酮应该成为血糖代谢异常患者的一个治疗目标。     

Prevalence of primary aldosteronism among bulgarian hypertensive patients

Primary aldosteronism (PA) has long been considered a rare disease, but a higher prevalence was suggested recently. The aim of this study was to evaluate the prevalence of PA in a group of Bulgarian hypertensive patients, including patients with adrenal incidentalomas (AI). The aldosterone to renin ratio (ARR)>750 was used as a positive screening test and the Captopril test was performed to confirm the diagnosis. Adrenal CT scan was used to differentiate between the main subtypes of PA- aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). The diagnosis of APA was retrospectively confirmed after surgery. After excluding other forms of endocrine hypertension, except PA, we investigated a total of 472 consecutive hypertensive patients, among them 96 patients with AI. Final diagnosis of PA was reached in 38 patients (8.05%) in the entire hypertensive population and in 12 patients (12.5%) among hypertensive patients with AI. In the group of PA, 15 patients (39.5%) were diagnosed with APA and 23 patients (60.5%) had an IHA. Among all patients with PA 21 (55.3 %) presented with hypokalemia. Our findings of a relatively high prevalence of PA support an early diagnosis of this potentially curable disease, especially in hypertensive patients with AI.     

Selection of patients for surgery for primary aldosteronism

1. Primary aldosteronism is a condition characterized by renin suppression and various degrees of hypertension and hypokalemia caused by aldosterone hypersecretion. 2. The adoption of the aldosterone-to-renin ratio determination as a screening test has led to an increase in the prevalence of diagnosed cases of primary aldosteronism. 3. Primary aldosteronism is confirmed by the demonstration of either sustained absolute aldosterone hypersecretion, or non-suppressible aldosterone hypersecretion. 4. Computed tomography and adrenal vein sampling can then be used to distinguish between idiopathic primary aldosteronism and the surgically remediable forms: aldosterone-producing adenoma and primary adrenal hyperplasia. 5. In patients with aldosterone-producing adenoma or primary adrenal hyperplasia, unilateral adrenalectomy generally results in the normalization of aldosterone secretion and kalemia, but normotension is achieved in only half of the cases. Nevertheless, in many cases without hypertension cure, adrenalectomy leads to an improvement in hypertension control with lower blood pressure levels and/or less antihypertensive medication.     

CLINICAL AND PATHOLOGICAL DIVERSITY OF PRIMARY ALDOSTERONISM, INCLUDING A NEW FAMILIAL VARIETY

1. Of 93 patients with primary aldosteronism seen during a 20 year period, 52 had an aldosterone-producing adenoma (APA) removed (five more await surgery), 14 had bilateral adrenal hyperplasia (BAH), three had glucocorticoid-suppressible hyperaldosteronism (GSH), one had adrenal carcinoma and 18 are yet to be categorized. 2. Seventy-three presented with hypertension and hypokalaemia. Others had markedly suppressed renal venous plasma renin activity (PRA) or elevated plasma aldosterone (PA)/PRA ratio, in new or resistant hypertensives. 3. The PA/PRA ratio was the most reliable screening test. 4. Diagnosis depended on the failure of suppression of aldosterone by salt loading and fludrocortisone. 5. Differentiation of BAH from APA depended on adrenal venous sampling comparing adrenal and peripheral venous PA/cortisol ratios. 6. A new familial variety of primary aldosteronism is described, with two affected members in each of three families. 7. Primary aldosteronism should be looked for in resistant and low-renin hypertension as well as in hypertension with hypokalaemia, and other family members should have PA/PRA measured if they are hypertensive.     

Results of adrenal surgery in patients with hypertension, aldosterone excess, and low plasma renin concentration.

Fifty patients with hypertension, aldosterone excess, and low plasma renin concentration underwent adrenal surgery. There was a highly significant fall in mean systolic and diastolic pressures after the operation. The mean postoperative diastolic pressure fell to strictly normal levels, however, in only 19 out of 38 patients from whom an adrenocortical adenoma was removed and in only two out of 10 non-tumour patients. There was a significant correlation between the fall in blood pressure during spironolactone treatment and after adrenal surgery though levels were generally slightly lower during the former therapy. It is suggested that removal of an aldosterone-producing adenoma is the treatment of choice provided a good preoperative hypotensive response to spironolactone occurs, while the treatment of choice for non-tumour patients is often long-term spironolactone.     

Is Primary Aldosteronism Underdiagnosed In Clinical Practice?

1. Primary aldosteronism is a syndrome consisting of hypertension, suppressed renin activity or concentration and high aldosterone levels in plasma or urine. The main steps in diagnosis are the determination of renin and aldosterone levels, the demonstration of renin-aldosterone dissociation and discrimination between idiopathic hyperplasia and Conn's adenoma, with only Conn's adenoma amenable to surgery. 2. Patients with resistant hypertension and/or hypokalaemia should be screened for primary aldosteronism with simple, redundant hormonal tests. The aldosterone to renin ratio is a logical initial screening test, a high ratio demonstrating renin-aldosterone dissociation. Criteria for a high ratio should be determined in each laboratory. 3. In patients with documented primary aldosteronism, computed tomography scan and adrenal vein sampling help to distinguish between idiopathic hyperplasia and Conn's adenoma. 4. Patients with low renin hypertension, idiopathic hyperplasia and Conn's adenoma have overlapping values for plasma concentrations of potassium, renin and aldosterone and the aldosterone to renin ratio. Because primary aldosteronism subtypes are quantitative diseases, the true prevalence of primary aldosteronism cannot be defined. 5. The use of sensitive screening tests (e.g. aldosterone to renin ratio) gives a higher prevalence of diagnosed cases of primary aldosteronism, but not of surgically correctable forms. Therefore, there is no clinical evidence that primary aldosteronism is underdiagnosed. 6. There is a need for tests to predict the postoperative blood pressure outcome of surgery in subjects with Conn's adenoma.     

The effect of 8 weeks treatment with the calcium antagonist felodipine on blood pressure, heart rate, working capacity, plasma renin activity, plasma angiotensin II, urinary catecholamines and aldosterone in patients with essential hypertension.

The effect of 8 weeks treatment with the calcium antagonist felodipine--a new long-acting dihydropyridine derivative--in a dose of 10 mg twice daily was studied in 10 male patients with essential hypertension, WHO grade I-II, aged 25-62 years. Diastolic blood pressure was reduced in supine and upright position. Systolic blood pressure was reduced only in the upright position. Heart rate was unchanged in the supine and decreased in the upright position. During dynamic exercise blood pressure was reduced. The maximal working capacity decreased, whereas the maximal heart rate attained was unchanged. Twenty-four hour urinary noradrenaline excretion, plasma renin activity and 24 h urinary aldosterone excretion were increased. Plasma angiotensin II and 24 h urinary adrenaline excretion were unchanged. In conclusion, felodipine is an effective long-acting blood pressure lowering drug with minor side effects. After 8 weeks on felodipine treatment heart rate was not increased, although the activity of the sympathetic nervous system and the renin-aldosterone system seemed enhanced.     

ALDOSTERONE-PRODUCING ADENOMAS RESPONSIVE TO ANGIOTENSIN POSE PROBLEMS IN DIAGNOSIS

1. A subgroup of patients with aldosterone-producing adenoma (APA) have been identified who lack many of the biochemical features regarded as characteristic of APA and used to distinguish APA from bilateral adrenal hyperplasia. 2. In these patients, aldosterone is responsive to infused angiotensin II (angiotensin-responsive APA), which explains their uncharacteristic responses to upright posture, saline infusion and fludrocortisone acetate administration. 3. The angiotensin-responsiveness of these patients may derive from the contralateral adrenal gland, since renin levels are less completely suppressed in angiotensin-responsive APA than in angiotensin-unresponsive APA. 4. However, while the excretion of 18-oxo-cortisol was consistently increased in angiotensin-unresponsive APA, it was normal in angiotensin-responsive APA, consistent with biochemical and biosynthetic distinctiveness residing in the tumours. 5. Angiotensin-responsive APA should always be considered as an alternative diagnosis to bilateral hyperplasia causing primary aldosteronism.     

醛固酮瘤患者糖代谢紊乱的患病情况

目的评价醛固酮瘤患者糖代谢紊乱的患病情况。方法检测65例醛固酮瘤患者的血压、血、尿醛固酮、血浆肾素活性基础及激发值,并行口服糖耐量检查,计算胰岛素敏感指数(ISI)、HOMA指数(HOMA IR)、葡萄糖及胰岛素曲线下面积(AUCG,AUCI),将所得结果与40例正常对照组进行比较。结果根据1999年WHO标准,醛固酮瘤患者中伴糖代谢紊乱者44.6%,糖调节受损者21.5%,糖尿病者23.1%,均高于对照组17.5%、10.0%、7.5%。根据OGTT结果将醛固酮瘤患者分为伴有(组1)及不伴有糖代谢紊乱(组2)两组进行比较,组1患者空腹、糖负荷后2h血糖、AUCG及AUCI均高于组2患者,组间比较有统计学差异(P<0.05)。组1患者血醛固酮、收缩压及舒张压高于组2患者,组间比较有统计学差异(P<0.05)。相关性分析结果醛固酮瘤患者AUCG与8:00血醛固酮呈正相关。结论醛固酮瘤患者糖代谢紊乱的患病率升高,而且其原因与醛固酮的高分泌有关。     

RENIN GENE POLYMORPHISM ASSOCIATED WITH ALDOSTERONE RESPONSIVENESS TO THE RENINANGIOTENSIN SYSTEM IN PATIENTS WITH ALDOSTERONE-PRODUCING ADENOMAS

1. Aldosterone levels in patients with unilateral aldosterone-producing adenomas may be responsive or unresponsive to the renin-angiotensin system, with the former often previously misdiagnosed as bilateral adrenal hyperplasia. 2. In tumours from patients in the responsive subgroup, renin mRNA is expressed in greater amounts than in tumours from patients in the unresponsive subgroup, or in normal adrenals. 3. We compared the frequency of four renin gene polymorphisms in peripheral blood DNA from the two subgroups and found significant associations between BglI, TaqI and HinfI restriction fragment length polymorphisms (RFLP) and aldosterone responsiveness. 4. Allelic variation in the constitutive renin gene was associated with a specific cause of hypertension.