性别对ARR在原发性醛固酮增多症筛查中的价值的影响

目的 探讨性别对血浆醛固酮/肾素活性比值(PAC/PRA,ARR)在原发性醛固酮增多症(简称原醛症)筛查中的价值的影响.方法 搜集1992-2014年在解放军总医院确诊的451例原醛症及300例原发性高血压(EH)患者的临床资料,根据性别进行分组,比较组间临床特点及生化指标,利用受试者工作特征曲线(ROC)寻找不同性别ARR的最佳诊断切点.结果 原醛症患者血浆醛固酮、血钠及ARR明显高于EH患者(P<0.01),但血浆肾素活性(PRA)、血钾及体重指数(BMI)明显低于EH患者(P<0.01),两组年龄、高血压病程及血压水平无明显差异(P>0.05).无论在原醛症或EH患者中,男性PRA均明显低于女性,但立位醛固酮未见明显差异(P>0.05).男性患者中筛查原醛症的最佳ARR切点为19.11,曲线下面积(AUC)为0.968,敏感性为92.44%,特异性为93.08%,约登指数(YI)为0.86;女性患者中ARR最佳诊断切点为27.26,AUC为0.956,敏感性为92.07%,特异性为90.00%,YI为0.82.当根据总体人群最佳切点调整男性或女性ARR值时,二者YI均下降.男性最佳ARR切点要小于现阶段国内外指南推荐范围.结论 性别是影响利用ARR筛查原醛效率的重要因素,应考虑设立性别相关的切点,女性最佳切点可能高于男性.

Effects of gender on screening value of aldosterone-renin ratio for primary aldosteronism

Objective To explore the potential influence of gender on screening value of aldosterone-renin ratio (ARR) for primary aldosteronism (PA).Methods The biochemical parameters were collected of 451 PA patients and 300 essential hypertension (EH) patients who were diagnosed in the General Hospital of PLA from 1992 to 2014. Each group was then divided into two groups by gender. The clinical characteristics were compared and then the receiver operating characteristic curve (ROC) was conducted to evaluate the best cut-off value.Results The plasma aldosterone concentration (PAC), serum sodium and ARR were much higher, but the plasma rennin activity (PRA), serum potassium and BMI were much lower in PA patients than in EH patients (P<0.01), and no significant difference existed between the two groups in age, duration of hypertension and blood pressure. The PRA was obviously lower in males than in females either in PA or in EH patients, but no signicantcant difference existed between males and females in PAC (P>0.05). The best cut-off value of ARR in male PA patients was 19.11, the relevant area under the curve (AUC) was 0.968, the sensitivity and specicantcity was 92.44% and 93.08%, and the Youden index (YI) was 0.86. The best cut-off value of ARR in female PA patients was 27.26, with AUC 0.956, sensitivity 92.07%, specicantcity 90.00% and YI 0.82, respectively. If the cut-off value was set at 27.26 in males, the specicantcity would rise a little, but the sensitivity and YI would sharply decrease. Similarly, the sensitivity would increase a little but the specicantcity and YI would fall substantially if the cut-off value in females was set at 19.11. The best cut-off value of ARR in men was smaller than the ocantcial value recommended by guidelines.Conclusion Gender is an important factor should be considered while ARR is used in PA screening, and the cut-off value of ARR in screening female PA patients should be setting higher.