不同体位肾素活性变化值对原发性醛固酮增多症鉴别诊断的价值

目的评估不同体位肾素活性变化值在高血压患者中诊断原发性醛固酮增多症(PA)的效能。 方法研究对象为2010年1月至2012年12月新疆维吾尔自治区人民医院高血压科收治的307例需要行继发性高血压筛查的高血压病患者。所有患者已行常规坐位肾素、醛固酮测定及立位、坐位、卧位肾素活性(PRA)、醛固酮测定、常规生化检测及人体学测量。满足坐位醛固酮/PRA值≥554 pmol/L·μg/ (L·h)]^－1并且盐水输注试验后醛固酮≥277 pmol/L的患者被定义为PA组，其余患者为非PA组。使用四格表计算相关指标的敏感度、特异度等。 结果PA组与非PA组立位、坐位、卧位三种体位PRA比较，PA组0.61 μg/(L·h)，0.62 μg/(L·h)，0.31 μg/(L·h)]低于非PA组1.42 μg/(L·h)，1.18 μg/(L·h)，0.51 μg/(L·h)]，差异有统计学意义(F＝11.465，12.052，10.296；P＝0.001)；PA组与非PA组体位变换后PRA差值比较，PA组立卧位PRA差值0.24 μg/(L·h)]低于非PA组0.78 μg/(L·h)]，差异有统计学意义(F＝8.303，P＝0.004)；立位后PRA<1.0 μg/(L·h)或立卧位PRA差值<0.6 μg/(L·h)单项指标诊断PA的敏感度分别为64%及70%，特异度分别为62%及68%，阴性预测值分别是91%及93%；立位后PRA<1.0 μg/(L·h)，联合立卧位PRA差值<0.6 μg/(L·h)诊断PA，其敏感度为45%，特异度为88%。 结论利用体位变换后PRA的变化值诊断PA效能较低，但有排除PA的临床价值，此试验患者配合度高，为生理性刺激试验，可安全有效地鉴别PA，联合试验后相关指标对诊断PA有临床参考价值。

Value of plasma renin activity changes with different posture on identification of primary aldosteronism

ObjectiveTo evaluate the diagnostic ability of primary aldosteronism(PA) via the changes of plasma renin activity(PRA) with postural variation in hypertensive patients. MethodsThree hundred and seven patients had received the estimation of PRA, aldosterone level on basal sitting posture and after 2 hours on upright, sitting and supine posture, and collection of other biochemistry measurements.PA group was defined according to aldosterone/renin acrivity ≥554 pmol/L·μg/ (L·h)]^-1 and plasma aldosterone concentration≥277 pmol/L after saline infusion test, the rest were regarded as no-PA group.Related parameters were calculated to show the sensitivity and specificity, and so on. ResultsIn PA group, the levels of PRA upright, sitting, supine 0.61 μg/(L·h), 0.62 μg/(L·h), 0.31 μg/(L·h)] were lower than those of no-PA group1.42 μg/(L·h), 1.18 μg/(L·h), 0.51 μg/(L·h)], and the differences were statistically significant (F=11.465, 12.052, 10.296; P=0.001). The D-value0.24 μg/(L·h)] of PRA between PRA upright and PRA supine in PA group was lower than that 0.78 μg/(L·h)] in no-PA group, and the difference was statistically significant (F=8.303, P=0.004). The sensitivity values of PRA upright <1.0 μg/(L·h) or PRA upright-PRA supine<0.6 μg/(L·h) to diagnose PA were 64% and 70%, respectively; the specificity values were 62% and 68%; the negative predictive values were 91% and 93%, respectively.Using PRA upright<1.0 μg/(L·h) and PRA upright-PRA supine <0.6 μg/(L·h) as diagnostic criterion of PA, the sensitivity and specificity values were 45% and 88%, respectively. ConclusionsThere is a low efficacy to use the changes of PRA via posture alteration as a diagnostic standard, but it′s brief and safe to provide some referenced information to doctors on the identification of PA.