基于血浆醛固酮／肾素浓度比的联合策略在原发性醛固酮增多症中的筛查价值

目的：探讨最适于临床筛查原发性醛固酮增多症（ PA）的方案。方法收集疑诊PA的病例303例,分为PA组、原发性高血压组和无功能性肾上腺皮质意外瘤组。利用血浆醛固酮／肾素浓度比值（ ARR）绘制受试者工作特征（ ROC）曲线,获取最佳诊断界值。进一步对目前临床关于PA筛查的方案进行对比分析。结果立位ARR的ROC曲线下面积明显高于卧位ARR及立、卧位血浆肾素、醛固酮。立位ARR诊断PA的最佳诊断界值[（ pg／ml ）／（μIU／ml）]为43．45,两次立、卧位试验中至少一次立位ARR ＞43．45时诊断PA的灵敏度最高,达0．94;两次立位ARR均＜43．45时,其除外PA的灵敏度为0．74,特异度为0．94,准确度为0．81。结论在高危人群中筛查PA,推荐行两次立位血浆肾素、醛固酮浓度测定,在两次中只要有一次立位ARR＞43．45即需考虑PA可能,并进一步进行确诊试验以避免漏诊。     

醛固酮瘤的影像学诊断评价(附22例分析)

1955年Conn 氏首次报道原发性醛固酮增多症(以下简称原醛),其临床和化验特征为高血压、低血钾、血和尿中醛固酮增多及血浆肾素活性降低。原醛增多的醛固酮主要     

原发性高血压PRA、AngⅡ分型和IGF-1水平的测定

目的 研究原发性高血压(EH)血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)分型和胰岛素样生长因子1(IGF-1)水平测定的临床意义.方法 用放射免疫法分析256例EH患者和70名正常对照者PRA和AngⅡ水平,酶免疫法分析IGF-1水平,并进行EH分型和组间对比的研究.结果 正常对照组PRA为(0.432±0.236)μg·L-1·h-1,AngⅡ为(31.7±7.4)μg/L.256例EH患者按PRA水平分型:增高者占18.0%,正常者占71.8%和降低者占10.2%;按AngⅡ水平分型:增高者占12.9%,正常者占76.2%和降低者占10.9%;血浆IGF-1水平随EH患者的血压水平升高而增高.结论 EH按PRA和AngⅡ水平分型以及对EH患者进行IGF-1水平的测定,有助于EH患者的治疗和随访.     

原发性醛固酮增多症

原发性醛固酮增多症 ,简称原醛症 ,是因肾上腺皮质发生肿瘤或增生 ,使醛固酮分泌过多 ,以高血压、低血钾、肌无力、高醛固酮和低肾素活性为主要特征的综合征。1　流行病学原醛症是继发性高血压的原因之一 ,在高血压人群中的患病率为 0 5 %～ 2 %。随着腹部B超、CT和MRI的广泛应用 ,许多无特征的病人也能被早期检出。Lim等从高血压 4 6 5例中筛检出原醛症4 3例 (占 9 2 % )。该症从新生儿至老人均可发病 ,但好发年龄为 30～ 5 0岁 ,其发病率在性别中没有差别 ,腺瘤多见于女性 ,男女之比约为 1∶1 2～ 1 5 ,国外报告为 1 2 3。2　病因…     

卡托普利、硝苯啶对高血压病患者血浆内皮素肾素-血管紧张素-醛固酮系统的影响

随着对高血压发生机制研究的不断深入,临床药理研究已从常规的生理、生化扩大到内分泌、细胞膜离子转运等新的领域.为了探讨血管紧张素转换酶抑制剂卡托普利及钙通道阻滞剂硝苯啶对高血压病(EH)患者治疗前、后血浆内皮素(ET)、肾素活性(PRA)、血管紧张素Ⅱ(ATⅡ)及醛固酮(ALD)浓度的影响,作者对24例EH患者分别用上述两药作对比研究.     

腺瘤型原发性醛固酮增多症的腹腔镜手术护理

原发性醛固酮增多症简称原醛症，是由肾上腺或异位组织分泌过多的醛固酮，抑制了肾素分泌，产生以高血压、低血钾为特征的综合征。我科于2005年2月收治1例因左肾上腺腺瘤致原醛症的患者，应用腹腔镜行左肾上腺腺瘤切除术。经过密切监测其病情变化，给予精心的术前、术后护理和出院指导，现已康复。     

醛固酮瘤的影这诊断评价（附22例分析）

1955年Conn氏首次报道原发性醛固酮增多症（以下简称原醛），其临床和化验特证为高血压，低血钾，血和尿中醛固酮增多及血浆肾素活性降低，原醛增多的醛固酮主要来自肾上腺醛固酮分泌性腺瘤（以下简称醛固酮瘤）（1，2），及时摘除本腺瘤，原醛症状即告消失，故对醛固酮瘤的准确诊断和定位具有重要意义，我院于1986年7月－1987年5月手术治疗22例原醛，术前曾采用下列四种检查方法：腹部平片和静脉尿路造影，核素扫描，超声和CT，本文就以上各方法定位诊断的准确率进行对比分析，结合手术与病理结果并复习有关文献对各方法予以评述。     

甲亢病人T_3、T_4值与肾素、血管紧张素Ⅱ和醛固酮水平的关系

对31例初发的甲亢病人和20名正常人对照观察了T_3、T_4和肾素(PRA)、血管紧张素Ⅱ(AⅡ)、醛固酮(PAC),显示甲亢病人血浆PRA值是正常人的1.9倍,AⅡ值是正常人的1.5倍,PAC值是正常人的2倍,支持甲亢高血压属高肾素性高血压;且发现在T_3、T_4与PRA、AⅡ、PAC之间呈正相关。支持肾素-血管紧张素-醛固酮(RAA)系统在甲亢高血压中起重要作用。但并未发现血压与AⅡ间有比例关系。提示甲亢病人的高血压是由多种因素造成的。     

原发性高血压血中SOD与RAAS关系的探讨

氧自由基对人体的损害作用已引起医学界的广泛注意。超氧化物歧化酶(SOD)与很多疾病的关系也在不断得到证实。为探讨原发性高血压患者血中SOD与肾素-血管紧张素-醛固酮(RAAS)的关系,我们检测了60例原发性高血压患者血中SOD-1与肾素(PRA)血管紧张素Ⅱ(A Ⅱ)和醛固酮(ALD)的含量,报告如下。     

卡维地洛对急性心肌梗死患者神经内分泌激素及心功能的影响

为评价卡维地洛对急性心肌梗死(AMI)患者神经内分泌激素水平及心功能的影响 ,将 5 2例AMI患者随机分为卡维地洛组、美托洛尔组和对照组 ,于治疗前和治疗后 6个月分别采血检测血浆肾素活性 (PRA)、血管紧张素Ⅱ(AngⅡ)浓度、血浆醛固酮 (Ald)浓度、血浆去甲肾上腺素 (NE)和肾上腺素 (E)浓度 ,并测定左心室射血分数 (LVEF)和左心室腔径变化。结果显示 ,卡维地洛组治疗后血浆PRA、NE、E水平以及美托洛尔组治疗后血浆PRA水平与对照组比较均显著下降 (P <0 0 1) ;卡维地洛组治疗后与治疗前比较LVEF增加(P <0 0 1) ,与对照组比较 ,左心室舒张末容量 (LVEDV)减小 ,LVEF增加 (P <0 0 5 )。提示卡维地洛可以抑制心肌梗死后神经内分泌激素的过度激活 ,从而减缓左心室重塑 ,改善心功能     

Adrenal Vein Sampling Results and Surgical Outcomes in Patients with a Normal Plasma Aldosterone Concentration

PurposeTo determine the utility of adrenal vein sampling (AVS) and outcomes after adrenalectomy in patients with normal plasma aldosterone concentration (PAC) and elevated aldosterone-to-renin ratio (ARR).Materials and MethodsThe study sample included 106 patients with ARR greater than 20 and PAC between 5 and 15 ng/dL (normal PAC group) who underwent AVS from 2005 to 2021. These patients were compared with a cohort of 106 patients with ARR >20 and PAC >15 ng/dL (high PAC group) who underwent AVS during the same period. Data regarding baseline clinical characteristics, lateralization indices from AVS, and outcomes after adrenalectomy were analyzed.ResultsAVS was technically successful in 210 patients (210/212, 99%). A smaller proportion of patients in the normal PAC group showed a lateralization index of >4 compared with those in the high PAC group (44% vs 64%, P <.01). A similar proportion of patients in the normal PAC group experienced improved or cured hypertension after adrenalectomy compared with that in the high PAC group (94% vs 88%, P =.31). Hypokalemia was cured in all patients in the normal PAC group after adrenalectomy compared with 98% of patients in the high PAC group (100% vs 98%, P = 1).ConclusionsAlthough lateralization is less frequent for patients with normal PAC, patients who do lateralize show similar blood pressure response and correction of hypokalemia after adrenalectomy, regardless of initial plasma aldosterone levels. Therefore, patients with PAC <15 ng/dL should still be considered for AVS provided the ARR is elevated.     

Determination of sex from the femur in Anatolian Caucasians: a digital radiological study

Determination of the sex is one of the most important steps when evaluating decomposed bodies or skeletal remnants. However, relevant data exhibit significant ethnic and temporal variation. This study provides information on in vivo femoral dimensions of Anatolian Caucasians. 50 males and 54 females with ages between 18 and 68 years were investigated with computed tomography. For males, mean maximum length (ML) was 448.2mm, mean vertical head diameter (VHD) was 48.8mm, mean midshaft transverse diameter (MTD) was 26.5mm, and mean anterior bowing (AB) was 759.3mm. For females, these were 419.0mm, 43.4mm, 25.6mm, and 779.5mm, respectively. Femoral dimensions of Anatolian Caucasians were not entirely similar to a single racial group that was already reported. There was a significant difference between males and females regarding ML and VHD (p<0.0001 for both). MTD and AB did not exhibit sexual dysmorphism. Discriminant analysis for sex type produced 83.3% accuracy when ML was used, and 76.9% accuracy when VHD was used (p<0.0001). Combined use of both parameters increased overall accuracy to 84.6% (p<0.0001). For VHD, cut-off value of 44.9mm produced 94% sensitivity and 83% specificity. For ML, cut-off value of 428.6 produced 80% sensitivity and 67% specificity.     

Validation of third molar maturity index (I3M) for discrimination of juvenile/adult status in South Indian population

Deliberate falsification of age was considered to be one of the main reasons for forensic age estimation of the living individuals. This posed to be a challenging task during criminal and legal proceedings, and ultimate care must be taken not to classify juveniles as adults. Third molars are the only developing teeth during late adolescence and early adulthood. Our study was designed to analyze the usefulness of the third molar maturity index (I_3M) specific cut-off value (I_3M < 0.08) to discriminate adults (≥18 years) and juveniles (<18 years) in South Indian children.216 panoramic radiographs (114 females and 102 males) of living subjects aged between 14 and 21 years were analyzed. Our results demonstrated high sensitivity (83.3% and 90.2%) and specificity (98.3% and 95.1%) for females and males respectively. The positive likelihood ratios of being adult were 50.00 and 18.35 while the negative likelihood ratios were 0.17 and 0.10 in females and males respectively. The estimated posttest probability was 98.0% in females and 94.8% in males. The obtained results showed that the specific cut-off value of I_3M < 0.08 may be a useful additional tool in discrimination of individuals who are around 18 years of age.     

Fat-free mass as a function of fat mass and habitual activity level.

The best predictor of energy expenditure in man is the fat-free mass of the body. Fat-free mass explains most of the variation in resting metabolic rate and even in total metabolic rate under sedentary conditions. We studied possible determinants of fat-free mass as routes to influence energy metabolism. Existing data sets were analysed with observations on height, fat mass (FM), fat-free mass (FFM), and habitual level of physical activity (PA). PA was calculated from average daily metabolic rate (ADMR) as measured over 1-4-week intervals with 2H2(18)O and basal metabolic rate (BMR): PA = ADMR/BMR. Ninety-six subjects, 66 females and 30 males, from 7 different studies were included. FFM and FM were adjusted for height by taking its ratio to the square of height, in analogy with the body mass index. Subsequently, all analyses were corrected for origin of the data. In a regression analysis FM explained 53 and 40% of the variation in FFM in females and males, respectively. Adding PA to the model raised the explained variation in FFM in females to 62%. In contrast with females (r = 0.10, n.s.), there was an independent relationship between PA and FM in males (r = -0.41, p less than or equal to 0.05), such that a higher PA was related to a lower FM. In conclusion, FFM is a function of FM and PA. The absence of an effect of exercise training on FFM, i.e. additional exercise in weight-reduction programmes, is discussed.     

Atrial natriuretic peptide and the renin-aldosterone axis during exercise in man

Under non-exercise conditions, atrial natriuretic peptide (ANP) elevation suppresses plasma renin activity (PRA) and aldosterone (PA). A similar effect of ANP on PRA-PA during exercise has been suggested but not demonstrated. We measured ANP, PRA, PA, plasma potassium (K+), and changes in plasma volume (PV) and blood volume (BV) at rest and during incremental cycle ergometer exercise to exhaustion in ten healthy males. Plasma concentrations (mean +/- SE) of hormones and electrolytes increased (P less than 0.05) during exercise: ANP (68 +/- 14 to 207 +/- 48 pg.ml-1), PA (11.2 +/- 2.2 to 18.8 +/- 3.4 ng.dl-1), PRA (5.1 +/- 1.1 to 8.2 +/- 1.6 ng.ml-1.90 min-1), and K+ (4.2 +/- 0.1 to 5.5 +/- 0.1 mEq). PV and BV declined, reaching maximal deflections from baseline during the 100% stage (12.9 +/- 1.5 and 8.4 +/- 0.8% decreases, respectively). There were positive correlations between ANP and PRA (r = 0.58; P less than 0.01), ANP and PA (r = 0.56; P less than 0.01), and PRA and PA (r = 0.80; P less than 0.001). Increases in K+ did not correlate with increases in PA. The fall in PV correlated with elevations in PRA (r = -0.67; P less than 0.01) and PA (r = -0.58; P less than 0.01), and the fall in BV correlated with elevations in PRA (r = -0.62; P less than 0.01) and PA (r = -0.44; P less than 0.02). ANP production was related to exercise intensity (gauged by heart rate response; r = 0.58; P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

视觉定性评估法与半定量分析法在18F-florbetabenβ-淀粉样蛋白显像中的准确性比较

目的比较视觉定性评估法和半定量分析法用于¹⁸F-氟比他班(FBB)β-淀粉样蛋白(Aβ)显像诊断阿尔茨海默病(AD)的准确性并探讨其临床应用价值。方法前瞻性纳入2019年1月至2019年10月间解放军总医院临床诊断为可能的轻/中度AD患者17例[男8例,女9例,年龄(74.1±8.5)岁]和认知功能正常志愿者(NC)17名[男9名,女8名,年龄(64.5±6.3)岁]。所有受试者均行动态¹⁸F-FBB PET/CT脑显像。采用视觉定性评估法和半定量分析法分析PET脑显像结果。采用两样本t检验比较2种方法所得标准摄取值比值(SUVR)差异;2种方法与临床结果的一致性采用Kappa检验分析;采用受试者工作特征(ROC)曲线确定诊断AD的SUVR最佳界值。结果视觉定性评估诊断AD的灵敏度、特异性和准确性分别为14/17、16/17和88.2%(30/34)。NC组和AD组全脑SUVR分别为1.09±0.85和1.75±0.25,复合皮质SUVR分别为1.16±0.57和1.89±0.15,差异均有统计学意义(t值:-10.263和-10.789,均P<0.001)。半定量分析法诊断AD的SUVR最佳界值为1.47,灵敏度、特异性和准确性分别为15/17、16/17和91.2%(31/34)。视觉定性评估法和半定量分析法与临床诊断结果的一致性都较好(Kappa值:0.765和0.824,均P<0.001)。结论视觉定性评估法和半定量分析法用于¹⁸F-FBB Aβ显像诊断AD都具有较高的准确性,但视觉定性评估法简洁清晰易掌握,在临床工作中值得进一步推广和使用。     

Validation of the third molar maturity index cut-off value of <0.08 for indicating legal age of 18 years in Eastern Chinese region

Having a reliable, inexpensive and simple method to estimate 18 years of age would be of help in the forensic field. This study aimed to test the accuracy of the third molar maturity index (I_3M) in indicating the legal adult age of 18 years. This retrospective cross-sectional study analysed 450 digital panoramic images of Eastern Chinese children and young adults (226 females and 224 males) aged between 14 and 22 years. A cut-off value of I_3M < 0.08 was tested in discriminating adults from minors for both sex. For females, the sensitivity of the test (Se) was 75.0%, with a 95% confidence interval (95%CI) of 67.5% to 82.5%. The specificity of the test (Sp) was 100%. The proportion accurately classified (Ac) individuals was 85.8% (95%CI, 81.3% to 90.4%). The Bayes post-test probability was 100% (93.6% to 100%). For males, Se, Sp and Ac were 91.9% (95%CI, 87.1% to 96.7%), 92.0%(95%CI, 86.7% to 97.3%) and 92% (95%CI, 88.4% to 95.5%), respectively. The Bayes post-test probabilities was 92% (95%CI, 88.4% to 95.5%). Males were ahead in the development of third molars comparing to females according to I_3M. A stepwise logistic regression analysis showed that both I_3M and sex contribute to the regression model to discriminate adults (≥18 years) from minors (<18 years), while a receiver operating curve (ROC) analysis indicated some better accuracy of I_3M < 0.12 in females, without statistically significant difference when compared to I_3M < 0.08.The results of this study show that the cut-off value of I_3M < 0.08 may help to discriminate Eastern Chinese adults from minors. However, further study should evaluate the usefulness and possible variability of I_3M cut-off value in a specific population before used for legal and forensic procedures.     

Accuracy of a rapid 10-minute carbon-14 urea breath test for the diagnosis of Helicobacter pylori-associated peptic ulcer disease

Urease in the human gastric mucosa is a marker for infection with Helicobacter pylori (HP), an organism which is associated with peptic ulcer disease. To detect gastric urease, we examined 184 patients (144 males, 40 females; mean age: 49.8±15.6 years) with suspected peptic ulcer disease. Fasting patients were given orally 5 Ci of carbon-14 labelled urea. From each patient only one breath sample was collected in hyamine at 10 min. The amount of ¹⁴C collected at 10 min was expressed as follows: [(DPM/mmol CO₂ collected)/(DPM administered)] × 100 × body weight (kg). The presence of HP colonization was determined by examination of multiple endoscopic prepyloric antral biopsy specimens subjected to culture or a rapid urease test. For the purpose of this study, HP-positive patients were defined as those with characteristic bacteria as indicated by a positive result of either the culture or the rapid urease test; HP-negative patients were defined as those with negative findings on both the culture and the rapid urease test. Of the 184 cases, 99 (53.8%) were positive for HP infection, and 85 (46.2%), negative. The sensitivity and specificity of the rapid 10 min ¹⁴C-urea breath test for the diagnosis of HP-associated peptic ulcer disease were evaluated by a receiver operating characteristic (ROC) curve with a variable cut-off value from 1.5 to 4.5. When a cut-off value of 1.5 was selected, the sensitivity was 100% and the specificity, 83.5%; when a cut-off value of 4.5 was selected, the sensitivity was 54.5% and the specificity, 97.6%. Correspondence to: Chia-Hung Kao     

Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI

OBJECTIVE: The coracohumeral interval previously has been described as predictive of subcoracoid impingement on dynamic screening. The purpose of this study was to determine whether a coracohumeral interval acquired from routinely performed MRI can reliably diagnose subcoracoid impingement. MATERIALS AND METHODS: Preoperative MRI examinations of 19 patients (16 males, three females) with subsequent surgical confirmation of subcoracoid impingement were reviewed retrospectively and compared with MRI studies of 41 control subjects (22 males, 19 females). Axial and oblique sagittal coracohumeral interval measurements were taken. The morphology of the coracoid process and lesser tuberosity was assessed. Postanalysis application of the data to two smaller groups of patients was performed. The first group consisted of nine subjects (three males, six females) for whom subcoracoid impingement was diagnosed prospectively on the basis of abnormalities found by MRI. The second group consisted of seven patients (two males, five females) who were referred for MRI evaluation because of clinically suspected subcoracoid impingement. RESULTS: The average coracohumeral interval for females was 3 mm smaller than that for males. Using sex-adjusted data, we found a statistically significant difference between individuals with or without subcoracoid impingement in the axial coracohumeral interval (p = 0.01). This value, however, was poorly predictive (area under the receiver operating characteristic curve, 0.73). An 11.5-mm axial coracohumeral interval had 84% sensitivity but only 44% specificity. A 10.5-mm axial coracohumeral interval had 79% sensitivity and 59% specificity. The shoulder morphologic features assessed and intraarticular contrast use were not statistically significantly related to the coracohumeral interval. In postanalysis application of data, in the group of nine subjects without clinical diagnosis of subcoracoid impingement, all prospective MRI subcoracoid impingement diagnoses were falsely positive. However, if subcoracoid impingement was the referring diagnosis, prospective MRI evaluation more often was correct (n = 7 [three true-negatives, two true-positives, two false-negatives]). CONCLUSION: A sex-adjusted coracohumeral interval of 10.5-11.5 mm, although statistically significantly related to subcoracoid impingement, is poorly predictive of this diagnosis when acquired via routinely performed MRI. Subcoracoid impingement is primarily a clinical diagnosis that may be supported, but not established, by this means.