钠盐摄入对卡托普利抑制试验和盐水负荷试验一致性的影响

目的:本研究旨在探讨不同水平钠盐摄入对两种原发性醛固酮增多症诊断试验卡托普利抑制试验(CCT)和盐水负荷试验(SIT)结果一致性的影响。方法:本研究回顾了中国医学科学院阜外医院自2016年10月至2018年8月同时行CCT和SIT的298例患者的临床资料。根据试验前24 h尿钠排泄量由低到高三等分将患者分为低钠组(<93 mmol/24 h)、中钠组(93~144 mmol/24 h)、高钠组(>144 mmol/24 h);四等分将患者分为低钠组(<75 mmol/24 h)、中钠组A(75~116 mmol/24 h)、中钠组B(117~164 mmol/24 h)、高钠组(>164 mmol/24 h),通过比较不同组别中CCT和SIT结果一致性的差异来探讨钠盐摄入对两种不同确诊试验的影响。结果:共有145例(48.7%)患者两种确诊试验结果不同,其中103例(34.6%)呈CCT单阳性,42例(14.1%)呈SIT单阳性。三等分时高钠组中CCT单阳性比例较高(高钠组49.0%vs中钠组26.7%vs低钠组28.3%,P<0.001),四等分时结果相似(高钠组48.0%vs中钠组B 36.5%vs中钠组A 25.7%vs低钠组28.0%,P=0.018)。多因素Logistic回归分析显示,24 h尿钠排泄量是影响CCT单阳性患者比例的因素(P=0.006)。结论:高钠组患者CCT结果和SIT结果一致性低于中钠组。进行原发性醛固酮增多症诊断试验前应标准化钠盐摄入而非单纯不限制钠盐摄入。

Impact of Daily Salt Intake on the Consistency Between Catopril Challenge Test and Saline Infusion Test in Patients With Primary Aldosteronism

Objectives:According to the Endocrine Society Clinical Practice guidelines,patients are encouraged to liberalize sodium intake before primary aldosteronism(PA)confirmatory tests.However,the influence of excessively high sodium intake is uncertain.This retrospective study aimed to observe the influence of high salt intake on the PA confirmatory test——the captopril challenge test(CCT)and the saline infusion test(SIT).Methods:Two hundred and ninety-eight patients who underwent both CCT and SIT were enrolled,patients were divided into three groups according to their 24-hour urinary sodium excretion:low salt group(<93 mmol/24 h),medium salt group(93-144 mmol/24 h)and high salt group(>144 mmol/24 h),and four groups:low salt group(<75 mmol/24 h),medium salt group A(75-116 mmol/24 h)medium salt group B(117-164 mmol/24 h)high salt group(>164 mmol/24 h).Results:CCT and SIT results were inconsistent in 145(48.7%)patients,103(34.6%)were CCT positive only and 42(14.1%)were SIT positive only.When divided into three groups,the high salt group consisted of more CCT positive only patients than the medium and low salt group(49.0%vs 26.7%vs 28.3%,P<0.001).Similar results were shown when divided into four groups(48.0%vs 36.5%vs 25.7%vs 28.0,P=0.018).Multiple Logistic regression analysis showed that urinary sodium excretion was a significant factor influencing the proportion of CCT positive only patients(P=0.006).Conclusions:Excessive consumption of salt could influence the consistency between CCT and SIT,standardized salt intake of a medium dose consumption of salt before the PA confirmatory test might be helpful to increase the consistency between CCT and SIT among PA patients.