CAJ | 학술논문

目的比较应用血浆醛固酮/血浆肾素活性(PAC/PRA,ARR)及PAC/血浆肾素浓度(PAC/PRC,AARR)进行原发性醛固酮增多症(PA)筛查的特异性和敏感性差异,评价测定血浆肾素浓度在PA筛查中的价值,并比较不同体位下AARR的筛查效率.方法 (1)对28例通过确诊试验或手术病理证实的PA患者和51例原发性高血压患者测定卧位、立位1 h和立位2 h的AARR,比较不同体位和时间下测定的AARR在PA筛查中的效率.(2)对31例PA患者、242例原发性高血压患者及145名健康志愿者测定立位1h PAC、PRA和PRC,计算ARR和AARR,通过构建ARR和AARR对诊断PA的受试者工作特征曲线(ROC),比较两者在PA筛查中的敏感性和特异性,探讨AARR在筛查PA中的价值,并确定最佳的切点.结果 (1)卧位、立位1 h和立位2 h AARR的ROC曲线下面积分别是0.950(95%CI 0.906～0.994,P<0.01)、0.979(95%CI 0.956～1.000,P<0.01)和0.917(95%CI0.856～0.979,P<0.01).立位1 h AARR具有最高的筛查效率.(2)立位1 h Log-PRA和Log-PRC相关系数为0.705,Log-ARR和Log-AARR的相关系数为0.788.ARR和AARR的ROC曲线下面积分别为0.998(95%CI0.981～1.000,P<0.01)和0.957(95%CI0.929～0.985,P<0.01).AARR的最佳切点为42.36 ng·dl-1/ng·dl-1,其敏感性和特异性分别达到87.10%和93.75%.结论应用AARR和ARR在高血压患者中进行PA的诊断效果相当,以立位1 h测定的AARR具有最佳的筛查效率,最佳切点为42.36 ng·dl-1/ng·dl-1.
목적 비교응용혈장철고동/혈장신소활성(PAC/PRA,ARR)급PAC/혈장신소농도(PAC/PRC,AARR)진행원발성철고동증다증(PA)사사적특이성화민감성차이,평개측정혈장신소농도재PA사사중적개치,병비교불동체위하AARR적사사효솔.방법 (1)대28례통과학진시험혹수술병리증실적PA환자화51례원발성고혈압환자측정와위、립위1 h화립위2 h적AARR,비교불동체위화시간하측정적AARR재PA사사중적효솔.(2)대31례PA환자、242례원발성고혈압환자급145명건강지원자측정립위1h PAC、PRA화PRC,계산ARR화AARR,통과구건ARR화AARR대진단PA적수시자공작특정곡선(ROC),비교량자재PA사사중적민감성화특이성,탐토AARR재사사PA중적개치,병학정최가적절점.결과 (1)와위、립위1 h화립위2 h AARR적ROC곡선하면적분별시0.950(95%CI 0.906～0.994,P<0.01)、0.979(95%CI 0.956～1.000,P<0.01)화0.917(95%CI0.856～0.979,P<0.01).립위1 h AARR구유최고적사사효솔.(2)립위1 h Log-PRA화Log-PRC상관계수위0.705,Log-ARR화Log-AARR적상관계수위0.788.ARR화AARR적ROC곡선하면적분별위0.998(95%CI0.981～1.000,P<0.01)화0.957(95%CI0.929～0.985,P<0.01).AARR적최가절점위42.36 ng·dl-1/ng·dl-1,기민감성화특이성분별체도87.10%화93.75%.결론 응용AARR화ARR재고혈압환자중진행PA적진단효과상당,이립위1 h측정적AARR구유최가적사사효솔,최가절점위42.36 ng·dl-1/ng·dl-1.
Objective Plasma renin concentration (PRC) offers advantages in processing and standardization as compared with plasma renin activity (PRA). The aim of the study is to compare the sensitivity and specificity of plasma aldosterone concentration ( PAC)/PRA (ARR) and PAC/PRC (AARR) in screening primary aldosteronism ( PA ) in hypertensive patients and to observe the influence of different postures on PRC and AARR. Method ( 1 ) PAC and PRC in the supine position and after 1-hour and 2-hour upright posture were determined in 28 patients with PA and 51 patients with essential hypertension. The diagnostic efficacies during different postures were compared according to the ROC curve analysis. (2) 31 patients with PA, 242 patients with essential hypertension, and 145 normotensitive subjects were recruited in the study. The diagnostic efficacy of AARR in screening PA from hypertensive patients was evaluate. PAC, PRA, and PRC were measured by radioimmunoassay. Results ( 1 ) The AUC of AARR in the supine position, 1-hour and 2-hour upright posture were0.950 (95% CI0.906-0.994, P<0. 01), 0.979 (95% CI0.956-1.000, P<0.01) and 0.917 (95% CI 0. 856-0. 979, P<0. 01 ) respectively. AARR of 1 -hour upright yielded the highest screening efficiency. ( 2 ) The correlation coefficient index of Log-PRA and Log-PRC was 0. 705 ( P< 0. 01, n = 418 ), whereas the correlation coefficient index of Log-ARR and Log-AARR was 0.705 (P<0.01, n=418). The AUC of ARR and AARR were 0.998 (95% CI0. 981-1. 000, P<0.01 ) and 0.957 (95% CI0. 929-0.985, P<0.01 ) respectively according to the ROC curve. The optimal cutoff of AARR during upright 1 hour was 42.36 ng · dl-1/ng ·dl-1 ( sensitivity 87.10%, specificity 93.75% ). Conclusion The screening efficacy of AARR in screening PA in hypertensive patients was comparable with ARR. AARR measured after keeping upright 1 hour yielded the highest screening efficiency. The optimal cutoff of AARR was 42.36 ng · dl-1/ng ·dl-1.