液相色谱串联质谱法对原发性醛固酮增多症的诊断价值

目的： 探讨液相色谱串联质谱（LC-MS/MS）检测方法中的卡托普利试验（captopril test，CCT）和生理盐水输注试验（saline infusion test，SIT）对原发性醛固酮增多症（primary aldosteronism，PA）的诊断价值。方法： 选取2018年2月至2019年2月复旦大学附属中山医院内分泌科收治的高血压患者127例，其中111例患者行CCT试验，101例患者行SIT试验。通过LC-MS/MS方法检测患者试验前后血浆醛固酮浓度（PAC）、肾素活性及醛固酮/肾素活性比值（aldosterone/renin ratio，ARR）水平。以手术或螺内酯试验为诊断金标准，采用CCT和SIT的ROC曲线探讨2种试验的诊断指标和最佳诊断截断值。结果： PA患者57例，原发性高血压患者70例。CCT后醛固酮、ARR及醛固酮抑制率的AUC分别为0.876、0.902和0.751；ARR为6.5时，诊断PA的灵敏度为94.2%，特异度为78%；PAC为34.8 pg/mL时，诊断PA的灵敏度为75.5%，特异度为93.2%。SIT后醛固酮、ARR及醛固酮抑制率的AUC分别为0.881、0.823和0.652；PAC为24 pg/mL时，诊断PA的灵敏度为87.2%，特异度为78.8%。结论： CCT后ARR和PAC均可作为PA的诊断指标，诊断截断值为6.5和34.8 pg/mL；SIT试验后PAC为PA诊断指标，诊断截断值为24 pg/mL。

Diagnostic value of liquid chromatography tandem mass spectrometry in primary aldosteronism

Objective: To explore the diagnostic value of captopril test (CCT) and saline infusion test (SIT) of liquid chromatography tandem mass spectrometry (LC-MS/MS) for patients with primary aldosteronism (PA). Methods: Clinical data of 127 hypertensive patients admitted to the Department of Endocrinology of Zhongshan Hospital from February 2018 to February 2019 were analyzed retrospectively. Serum aldosterone and renin levels were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Among the 127 patients, 111 patients underwent CCT test and 101 patients underwent SIT test. Surgery or spironolactone test was used as the gold standard for diagnosis. Totally, 57 patients were finally diagnosed with PA and 70 patients with essential hypertension. The changes in plasma aldosterone concentration (PAC), renin activity, and their ratios were analyzed before and after the experiment. The ROC curves were drawn up based on the aldosterone, aldosterone inhibition rate, and aldosterone/renin ratio (ARR). The AUC was compared and the best diagnostic cut-off point was analyzed. Results: PA patients had higher aldosterone and ARR levels, and a lower renin level. The AUC of aldosterone, ARR, and aldosterone inhibition rates were 0.876, 0.902, and 0.751 respectively after CCT; when the ARR was 6.5, the diagnostic sensitivity was 94.2% and the specificity was 78%. When the PAC was 34.8 pg/mL, the diagnostic sensitivity was 75.5%, and the specificity was 93.2%. The AUC of aldosterone, ARR, and aldosterone inhibition rates were 0.881, 0.823, and 0.652 after SIT. When the post-aldosterone cut-off point was 24 pg/mL, the diagnostic sensitivity was 87.2% and the specificity was 78.8%. Conclusions: Both post-ARR and PAC can be used as diagnostic indicators of PA after CCT, and the diagnostic cut-off points are 6.5 and 34.8 pg/mL, respectively. Post-PAC is the best diagnostic indicator of PA after SIT, and the diagnostic cut-off point is 24 pg/mL.