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原发性醛固酮增多症诊断切点的研究及临床应用

, PP. 1146-1149

Keywords: 原发性醛固酮增多症,醛固酮,醛固酮/肾素,诊断切点,肾上腺醛固酮腺瘤,肾上腺皮质增生

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Abstract:

目的探讨原发性醛固酮增多症(primaryaldosteronism,PA)患者立卧位醛固酮、醛固酮/肾素比值(ratioofaldosterone/rennin,ARR)的诊断切点,提高PA诊断的准确率。方法收集2006-2014年在我院诊断的PA患者45例及年龄相匹配的原发性高血压患者(essentialhypertension,EH)50例。PA患者均行病理诊断,其中34例术后病理证实为肾上腺醛固酮腺瘤,11例为肾上腺皮质增生。患者均行血钾、24h尿钾、立卧位肾素、血管紧张素Ⅱ、醛固酮、皮质醇节律、儿茶酚胺代谢产物等检测,计算ARR,利用受试者工作曲线(ROC)得到诊断PA立卧位醛固酮、ARR的最佳切点,评价不同指标诊断PA的敏感性及特异性。并比较两种不同病理结果间醛固酮及ARR的差异。结果PA组与EH组间性别、年龄和血压无明显差异,PA组肾素活性、血钾显著低于EH组,而醛固酮、ARR及24h尿钾均显著高于EH组。诊断PA的立位醛固酮的最佳切点为0.221ng/mL,敏感性(Sen)=0.561,特异性(Spe)=0.909;卧位醛固酮为0.175ng/mL,Sen=0.829,Spe=0.795;立位ARR为19.5(ng·dL-1)/(ng·mL-1·h-1),Sen=0.878,Spe=0.955;卧位ARR为20.5(ng·dL-1)/(ng·mL-1·h-1),Sen=0.902,Spe=0.841。在PA组中肾上腺醛固酮腺瘤的ARR较肾上腺皮质增生患者高,尤其立位ARR最为明显。结论立位醛固酮、ARR诊断PA的敏感性较卧位差,但特异性较强,所以临床对高血压患者行上述激素检查时应综合立卧位激素的检查结果,且其水平与病理有关。

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