血浆醛固酮/肾素活性比值在诊断原发性醛固酮增多症患者的价值

目的采用血浆醛固酮/肾素活性比值(ARR)在高血压患者中筛选原发性醛固酮增多症(原醛)病例,治疗和随访患者、分析其临床特点,从而探讨原醛的临床特点和 ARR 在原醛诊断中的价值。方法收集门诊和住院的高血压患者902例(其中3级高血压609例),空腹采血并用放射免疫方法测定血浆肾素和醛固酮水平及血生化指标,计算 ARR。对比值大于25(ng/dl 比ng·ml~(-1)·h~(-1))的126例疑诊为原醛的病例进行肾上腺薄层 CT 扫描,分析其临床特点、用抗醛固酮药物治疗并进行随访。结果原醛在高血压人群中占14%(126/902),肾上腺 CT 见54例单侧或双侧增生和25例腺瘤;原醛合并低血钾占39%(49/126);25例患者接受外科治疗,有效率100%,其中48%(12/25)能达到治愈;用螺内酯治疗有效率为89%(48/54),单药控制率为24%(13/54)。结论中国人原醛占高血压10%以上,ARR 应作为高血压尤其是重度和难治性高血压患者的常规检查,ARR 在原醛诊断中有重要意义,可以提高原醛的诊断率。

Aldosterone/plasma renin activity ratio is a sensitive parameter for screening patients with primary aldosteronism

Objective To screen primary aldosteronism cases with ARR(aldosterone/plasma renin activity,ARR)from patients with hypertension,and to evaluate the diagnosis value of ARR in primary aldosteronism cases and analysis the clinical characters of primary aldosteronism cases.Methods Nine hundred and two patients with hypertension were collected,the plasma aldosterone concentration to plasma renin activity ratio were detected by radio-immunity method,after that,ARR were calculated.Retrospective analysis was made of clinical data in 126 primary aldosteronism cases,which ARR were over 25.Results One hundred and twenty-six cases(14%)were diagnosed as primary aldosteronism,and of them,49 cases had hypokalemia.25 patients received surgical operation and the rate of efficiency and cure of surgery treatment were 100% and 48%,respectively.The rate of efficiency and cure of drug treatment was 89% and 24% respectively.Conclusions Primary aldosteronism affects over 10% of patients with hypertension in China.Patients with hypertension and most patients with treatment-resistant hypertension should undergo screening for primary aldosteronism with ARR.A high ARR is a positive screening test result,a finding that warrants confirmatory testing.