原发性醛固酮增多症功能诊断试验可靠性分析-第三军医大学学报.DOCVIP

　 原发性醛固酮增多症筛查诊断影响因素分析 许红峰 朱理敏 （上海交通大学医学院 瑞金医院高血压科 上海 200025） 文摘：目的：血浆醛固酮/肾素比值（ARR）是筛查原发性醛固酮增多症（以下简称原醛）的有效方法，但不同测定条件对结果影响较大，本研究比较卧立位对ARR比值及醛固酮的影响，并通过盐水确诊试验研究较有效的筛查条件。方法：将排除其他继发性高血压病因，严格换药后完成盐水确诊试验的84例高血压患者根据盐水试验结果分为原醛组（52例）和原发性高血压（以下简称原高）组（32例），统计立卧位血浆醛固酮（PAC）、肾素（PRA）AAR240（pg/ML）/[ng/（ML﹒h）,原高组立位AAR240（pg/ML）/[ng/（ML﹒h）14例（43.75%），尿醛固酮中位数14.34ug/24h，原高组AAR240且卧位PAC 150 pg/ ml者1例（3.13%）。原醛组立位AAR240（pg/ML）/[ng/（ML﹒h） 150 pg/ ml者34例（65.39 %）,此方法诊断原醛的特异性为96.88%。原醛组立位AAR240（pg/ML）/[ng/（ML﹒h） 150 pg/ ml及尿醛固酮10ug/24h者31例（59.62 %），此方法诊断原醛特异性为100%。结论：以立位ARR值240且卧位PAC 150 pg/ ml及尿醛固酮10ug/24h为标准是有效筛查原发性醛固酮增多症的方法。 关键词:原发性醛固酮增多症 ARR 尿醛固酮 盐水试验 Analyze the influencing factors for screening primary aldosteronism Xu Hongfeng Zhu Limin （Department of Hypertension, Ruijin Hospital School ofMedicine Shanghai Jiaotong University，Shanghai 200025，China） Abstract : Objective ：The assessment of the plasma aldosterone-to-renin ratio (ARR) is the most effectively and commonly used method for screening primary aldosteronism。ARR assessment is influenced by many factors，such as drugs intake，body position and serum potassium level etc。The objective of this study is to confirm the most effectively screening condition by comparing the ARR values of different positions after saline load test . Exclusion the other secondary hypertension，After the completion of saline dressing test ,84 cases diagnosed hypertensive patients under saline load test results are divided into primary aldosteronism group (52 cases) and primary hypertension group (32 cases) . Analyze plasma aldosterone (PAC), renin (PRA) values of upright and decumbent body positions , their ARR values are calculated and urine aldosterone are tested. results: Those whose upright position ARR ratios ＞240 accounted for 80.77%(42/52) and 43.75% (14/32), respectively in the both PA group and essential hypertension group; Those whose upright position ARR ratios ＞240 and decu