血浆醛固酮/肾素活性比值——一个敏感的原发性醛固酮增多症的筛查指标

血浆醛固酮／肾素活性比值（ARR）是一个敏感的原发性醛固酮增多症（PA）的筛查指标，ARR的应用使高血压人群中PA的检出率明显增加。但目前ARR仍是一个非标准化的筛选方法，不同研究所采用的ARR切点差别很大，故应对ARR进行更深入和系统的研究，以提高ARR筛查方法的准确性。     

原发性醛固酮增多症筛查中血浆醛固酮/肾素活性比值的影响因素

血浆醛固酮水平/肾索活性比值(ARR)是筛查原发性醛固酮增多症的实用指标.由于影响肾素和醛同酮分泌的因素众多,ARR切点值变异范围较大,至今仍然是一个缺乏标准化的指标.本文综述这些因素,旨在临床上提高ARR的诊断效力.     

88例原发性醛固酮增多症临床回顾分析

目的提高对原发性醛固酮增多症（简称原醛）的诊治水平。方法回顾性分析88例原醛患者的临床资料。结果血压水平、血浆醛固酮浓度（PAC）升高,血浆肾素活性（PRA）、血清钾离子浓度下降。醛固酮瘤占84．09％,特发性醛固酮增多症（简称特醛症）占15．91％。95．45％患者的血浆醛固酮／血浆肾素活性比值（ARR）〉20。醛固酮瘤患者具有更高的血浆醛固酮水平及更低的血浆肾素活性和血清钾离子浓度。结论ARR是原醛的重要筛查方法;卧立位试验及CT有助于肾上腺皮质腺瘤和增生的鉴别。     

原发性醛固酮增多症各项诊断筛查方法的临床价值

目的评价经手术病理证实的原发性醛固酮增多症(PA)患者术前各项诊断筛查方法与术后病理诊断的符合率。方法回顾性分析36例PA患者不同指标筛查PA的阳性率,各项确诊试验对PA确诊率及CT与术后病理的诊断符合率。结果在上述患者中,以血浆醛固酮与肾素比值(ARR)30 ng/dl为筛选条件筛查PA的阳性率为42%,以ARR50 ng/dl筛查PA的阳性率为64%(P0.01);盐水滴注抑制试验和卡托普利抑制试验对PA的确诊率分别为90.91%和92%(P0.05);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95.24%和73.33%(P0.05)。结论 ARR50 ng/dl筛查PA的阳性率高于ARR30 ng/dl;盐水滴注抑制试验与卡托普利抑制试验确诊率相当;对于分型,CT对APA的诊断符合率与UAH相当。     

溶血反应对高血压患者肾素－血管紧张素－醛固酮系统检测的影响

目的 探讨溶血反应对高血压患者血浆中肾素活性(PRA)、血管紧张素Ⅰ(Ang Ⅰ)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)及醛固酮/肾素活性比值(ARR)检测结果的影响.方法 将60例高血压患者血标本每例分成2份,每例标本各取l份施行模拟溶血,将溶血及非溶血样本离心后,分别取血浆,应用放射免疫法检测血浆PRA、Ang Ⅰ、AngⅡ、ALD及ARR水平,并对溶血组及非溶血组结果进行统计分析.结果 溶血样本PRA、Ang Ⅰ、AngⅡ、ALD水平均明显低于非溶血样本(P＜0.01),ARR假阳性率升高(P＜0.05).结论 溶血对血浆PRA、Ang Ⅰ、AngⅡ、ALD及ARR检测结果有显著影响,严重干扰临床诊断,在实际工作中应予以重视.     

在高血压患者中筛选原发性醛固酮增多症国人血浆醛固酮/肾素活性比值标准的探讨

目的血浆醛固酮/血浆肾素活性比值(ARR)测定是目前从高血压患者中检出原发性醛固酮增多症(原醛)患者最常用和有效的筛选方法。ARR 值在不同人种中有很大差别,测定条件对其结果影响较大。本研究在严格控制药物、体位等条件下,建立中国人筛选原醛 ARR 值。方法根据肾上腺增强 CT 检查结果,将110例高血压患者分为原发性高血压组(65例)和肾上腺腺瘤/增生组(45例)。停用对肾素和醛固酮分泌有影响的降压药物至少2周,利尿剂包括螺内酯停用4周。对于不宜停服降压药物的患者,改服非双氢吡啶类钙拮抗剂维拉帕米缓释片(varapamil-SR)和(或)α受体阻滞剂特拉唑嗪(terazosin)。低血钾患者补钾至正常水平。采血日晨起保持立位2 h 后,于上午9～10点立位取肘静脉血测定血浆肾素活性、血浆醛固酮浓度,计算 ARR。结果 ARR 值以醛固酮 pg/ml/肾素活性 ng·ml~(-1)·h~(-1)为单位。立位 ARR 值在原发性高血压组为100.00±48.65,肾上腺腺瘤/增生组为699.33±213.33。由 ROC 曲线所得切割值为240,立位 ARR 较卧位 ARR 更有筛查价值。在肾上腺腺瘤/增生组93.3%(42/45)患者的 ARR 值高于240,原发性高血压组90.7%(59/65)患者ARR 值低于该值。取 ARR 值240为切割点,我们从近178例高血压患者中检出15例原醛患者(手术病理证实),所有15例患者 ARR 均大于240,显示极高的敏感性和特异性。结论采用本研究试验条件,中国人立位 ARR 值为240。ARR 测定是一项简便、有效的原醛筛查方法,测定时须注意体位、药物、血钾的影响。     

苏北地区ALD,ARR,ALD联合ARR诊断原发性醛固酮增多症的价值

目的:评估血浆醛固酮(ALD)、醛固酮/肾素活性比值(ARR)、ALD联合ARR在高血压患者中对原发性醛固酮增多症(PA)的诊断价值.方法:收集于我院和医联体医院就诊的346例ARR＞15的高血压患者.根据卡托普利试验(CCT)/静脉盐水负荷试验(SIT)结果,患者被分为原发性高血压(EH)组(237例)和PA组(10...     

新疆乌鲁木齐地区原发性醛固酮增多症105例临床分析

目的分析原发性醛固酮增多症(PA)的临床表现、辅助检查及治疗情况。方法对1999年7月至2005年3月间连续确诊的105例患者的临床资料进行回顾性分析。结果89例患者中有低血钾者占85%,血浆立、卧位肾素活性处于正常低值,立、卧位醛固酮水平均增高。醛固酮和肾素活性比值(ARR)>25者占71%,ARR>50者占8%。81例行B超检查,99例行CT检查,20例行MRI检查,其阳性率分别为:51.9%,80.8%,85%。58例原发性醛固酮增多症患者行手术治疗,其中43例血压均恢复正常,15例仍需要药物继续控制血压。结论血浆肾素活性,血浆醛固酮水平,以及血浆醛固酮和肾素活性比值(ARR)是原发性醛固酮增多症的主要定性诊断方法。CT是原发性醛固酮增多症的主要定位诊断依据。外科手术是治疗原发性醛固酮增多症的重要方法。     

原发性醛固酮增多症的内分泌功能诊断

原发性醛固酮增多症(原醛症)是继发性高血压最常见的原因之一,以低肾素和高醛固酮血症为特征,血浆醛固酮/肾素比值(ARR)是筛查原醛症的可靠指标.而口服高钠负荷试验、生理盐水试验、氟氯可的松抑制试验或卡托普利试验中的任何一项均可作为ARR阳性患者的确诊试验;肾上腺静脉插管采血(AVS)是原醛症分型诊断的金标准.     

采用化学发光法测定的立位醛固酮与肾素比值筛查四川省高血压人群中原发性醛固酮增多症的切点

目的 应用化学发光法检测立位血浆醛固酮浓度(PAC)和直接肾素浓度(DRC),计算醛固酮与肾素比值(ARR),探索立位ARR用于筛查四川省高血压人群原发性醛固酮增多症(PA)的切点。方法 纳入2020年10月至2022年5月在四川大学华西医院内分泌代谢科进行PA筛查的高血压患者423例,采用化学发光法测定立位2 h的PAC、DRC,应用受试者工作特征(ROC)曲线确定立位ARR筛查PA的切点,进一步分析不同性别和年龄患者中ARR切点的变化。结果 在纳入的高血压患者中,确诊为PA 199例,原发性高血压(EH)224例。PA患者的立位ARR高于EH患者[12.1(5.5～30.0)比0.5(0.2～1.1)(ng/dL)/(mU/L),Z=-17.434,P<0.001]。ROC曲线显示,当立位ARR切点为2.4 (ng/dL)/(mU/L)时,约登指数最大,其敏感度为95.5%,特异度为94.2%。男、女患者筛查PA的立位ARR切点值分别为2.0、2.4 (ng/dL)/(mU/L),敏感度分别为96.5%、95.6%,特异度分别为95.3%、91.5%。年龄≤40、>40...     

Effect of age on aldosterone/renin ratio (ARR) and comparison of screening accuracy of ARR plus elevated serum aldosterone concentration for primary aldosteronism screening in different age groups

The serum aldosterone concentration (SAC)/plasma renin activity (PRA) ratio (ARR) is considered a useful screening test in the differential diagnosis of essential hypertension (EH) and primary aldosteronism (PA). The purpose of this study is to investigate the effect of age on ARR and compare the screening accuracy of ARR plus elevated SAC for PA screening in different age groups. Thirty-nine patients with PA, 274 patients with EH, and 153 healthy volunteers were recruited. Blood was sampled for SAC and PRA measuring under keeping upright posture for 1 h. Levels of SAC, PRA, and ARR were compared at different ages range for the respective three groups of subjects. The screening accuracy of ARR plus elevated SAC was compared in different age groups and PA patients served as the same positive subjects. In the EH group, logarithmically transformed ARR (Log-ARR) increased with advancing age and reached its peak in the ≥ 60 years group; in the normotensives group, Log-ARR reached its peak in the 40-49 years group and slightly declined with advancing age. In the PA group, Log-ARR was not age dependent. Screening accuracy increased when combined index of ARR and SAC was used in the ≥ 40 years group but not in the <40 years group. Although the number of EH patients with elevated ARR increased with advancing age, but the screening accuracy and cutoff values of ARR were not affected by age. Using the combined index of ARR and SAC increased the screening accuracy for the patients older than 40 years, but not necessary for the patients younger than 40 years.     

血浆醛固酮与肾素活性比值测定方法标准化问题的探讨

血浆醛同酮与血浆肾素活性比值(ARR)已广泛应用在高血压患者中筛查原发性醛同酮增多症(原醛).研究表明,不同的临床状况(测定方法)会得出不同的ARR.由于没有统一的ARR标准,使得其临床应用难以适从.因此,应该根据所选用的测定方法和本单位的试验条件,采用相应的,同时具最高敏感性、特异件和准确件的ARR.近年来通过控制测定条件,即所谓测定方法标准化,包括:停用降压药2～4周、取同定体位、上午8:00～12:00之间采血、充分钠摄入以及低血钾者补钾等,发现原醛的ARR范围大致在23.6～26.0 ng·dl-1·ng-1·ml-1·h-1之间,说明ARR筛查方法标准化有助于确定和统一筛查原醛的ARR标准.     

Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents

Primary aldosteronism (PA) is a common form of endocrine hypertension previously believed to account for less than 1% of hypertensive patients. Hypokalemia was considered a prerequisite for pursuing diagnostic tests for PA. Recent studies applying the plasma aldosterone/plasma renin activity ratio (ARR) as a screening test have reported a higher prevalence. This study is a retrospective evaluation of the diagnosis of PA from clinical centers in five continents before and after the widespread use of the ARR as a screening test. The application of this strategy to a greater number of hypertensives led to a 5- to 15-fold increase in the identification of patients affected by PA. Only a small proportion of patients (between 9 and 37%) were hypokalemic. The annual detection rate of aldosterone-producing adenoma (APA) increased in all centers (by 1.3-6.3 times) after the wide application of ARR. Aldosterone-producing adenomas constituted a much higher proportion of patients with PA in the four centers that employed adrenal venous sampling (28-50%) than in the center that did not (9%). In conclusion, the wide use of the ARR as a screening test in hypertensive patients led to a marked increase in the detection rate of PA.     

Confounders of the aldosterone‐to‐renin ratio when used as a screening test in hypertensive patients: A critical analysis of the literature

The aldosterone‐to‐renin ratio (ARR) is a common screening test for primary aldosteronism in hypertensives. However, there are many factors which could confound the ARR test result and reduce the accuracy of this test. The present review''s objective is to identify these factors and to describe to what extent they affect the ARR. Our analysis revealed that sex, age, posture, and sodium‐intake influence the ARR, whereas assay techniques do not. Race and body mass index have an uncertain effect on the ARR. We conclude that several factors can affect the ARR. Not taking these factors into account could lead to misinterpretation of the ARR.     

Aldosterone-to-renin ratio as a screening test for primary aldosteronism--the Dutch ARRAT Study

Since the introduction of the aldosterone-to-renin ratio (ARR ) as a screening tool for primary aldosteronism (PA), there has been a marked increase in the reported prevalence of this condition among hypertensive subjects. A meta-analysis from the literature shows a PA prevalence of almost 8% among hypertensive patients, with a twofold higher prevalence in referred patients as compared with primary care patients (9.0 vs 4.3%). However, the usefulness of the ARR remains subject of debate, because of doubts on its validity, and the many factors affecting the ARR , including posture, time of day of blood sampling, and use of antihypertensive medication. Furthermore, there is no clear cut-off value and it is unknown what population should be screened. Recently, The Dutch ARR AT Study was initiated. This is a multicentre, prospective trial aiming to evaluate the test characteristics of the ARR within a Dutch population of therapy-resistant hypertensive patients. The effect of antihypertensive medication on the ARR will be studied. Furthermore, from this study the prevalence of PA in this population will follow. Last, the blood pressure response to the selective aldosterone-receptor-antagonist eplerenone will be evaluated. The Dutch ARR AT Study will run until the end of 2009 and will contribute to the formulation of uniform guidelines for the screening for PA in the Netherlands.     

The effect of medication on the aldosterone‐to‐renin ratio. A critical review of the literature

The aldosterone‐to‐renin ratio (ARR) is a common screening test for primary aldosteronism in hypertensives. However, patients often use medications that could confound the ARR and, thereby, reduce the interpretability of the test. Since it is not always feasible to stop such medication, several drugs that are supposedly neutral with respect to the ARR have been recommended as alternative treatment. The objective of the present review is to explore whether sufficient evidence exists to justify the recommendations. To this end, we performed a systematic PubMed and Cochrane literature search regarding medications that may influence the ARR. Our review revealed that many commonly prescribed antihypertensives seem to have significant effects on renin, aldosterone, and resulting ARR values. However, the magnitude of these effects is poorly quantifiable with the present level of research. We conclude that several medications can affect the ARR. Not taking this into account could lead to misinterpretation of the ARR. Therefore, standardization of the medications used during ARR measurement is advisable for a reliable and accurate interpretation. Further research is needed to ascertain how to best optimize these medications.     

Validity of plasma aldosterone-to-renin activity ratio in African American and white subjects with resistant hypertension

BACKGROUND: Recent reports suggesting that primary aldosteronism (PA) is more common than historically thought have often relied on use of the plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio (ARR) to identify patients with PA. Prior determinations of the validity of the ARR had been generally limited to subjects that could be withdrawn from antihypertensive therapy and to non-African American subjects. METHODS AND RESULTS: The current study was designed to evaluate prospectively the diagnostic value of the ARR in treated African American and white subjects with resistant hypertension. Consecutive subjects referred to a university hypertension clinic for resistant hypertension were evaluated with an early morning ARR and a 24-h urinary aldosterone and sodium. The presence of PA was defined as a suppressed PRA (<1.0 ng/mL/h) and elevated urinary aldosterone excretion (>12 microg/24 h) during high dietary sodium ingestion (>200 mEq/24 h). In 58 subjects, PA was confirmed. The ARR was elevated (>20) in 45 of 58 subjects with PA and in 35 of the 207 patients without PA, resulting in a sensitivity of 78% and specificity of 83% with a corresponding positive predictive value of 56% and a negative predictive value of 93%. Among African American subjects, the ARR was less sensitive than in white subjects (75% v 80%), but it still had a high negative predictive value (92% v 94%). CONCLUSIONS: These data indicate that the ARR is valid as a screening test for PA in African American and white patients on stable antihypertensive treatments, but a high percentage of false-positive results precludes using it for accurate diagnosis of PA.     

Partial remission of metastatic papillary thyroid carcinoma with sunitinib. Report of a case and review of the literature

The ratio of aldosterone-to-renin activity is currently recommended as a screening test for primary aldosteronism (PA). There are many factors interfering the interpretation of aldosterone-renin ratio (ARR) and could hamper in-time diagnosis of PA. Here, we first report a patient with underlying Page phenomenon and an accidentally disclosed adrenal incidentaloma. High renin secretion from Page phenomenon had masked higher ARR into normal ARR obscuring the diagnosis of PA. However, adrenal venous sampling (AVS) confirmed the autonomous aldosterone secretion with left adrenal vein plasma aldosterone concentration (PAC) 124.1 ng/dl and a lateralization ratio 3.3. AVS may discriminate masked PA due to high renin secretion from Page kidney. It is suggested that clinicians should cautiously interpret aldosterone-renin ratio and consider diagnostic AVS if hyperaldosteronism is highly suspected especially in the background of other secondary hypertension.