CAJ | 학술논문

目的回顾分析瑞金医院内分泌科近5年怀疑原发性醛固酮增多症患者的资料,用受试者工作特征( receiver operating characteristic,ROC)曲线下面积评估醛固酮/肾素比值(aldosterone to renin ratio,ARR)在诊断原发性醛固酮增多症(原醛症)中的临床价值.方法收集瑞金医院内分泌科2006年1月至2010年8月行卧位及立位ARR测定的590例怀疑原发性醛固酮增多症入院患者的临床资料,其中确诊为原醛症的患者357例,确诊为原发性高血压的患者233例.分析瑞金医院内分泌科2010年9月至2011年4月行随机及立位ARR测定的100例怀疑原醛症患者的临床资料,其中确诊为原醛症的患者29例,确诊为原发性高血压的患者71例.综合分析卧位、立位及随机ARR ROC曲线,以确定合适的切点用于诊断原发性醛固酮增多症.结果 2006年1月至2010年8月行卧位及立位ARR测定的590例患者卧位ARRROC曲线下面积为0.838(0.805～0.867),立位ARR ROC曲线下面积为0.873(0.843 ～0.899),两曲线下面积比较有显著差异(P＜0.01).2010年9月至2011年4月行立位及随机ARR测定的100例患者立位及随机ARR ROC曲线下面积分别为0.962(0.928 ～0.995)及0.944(0.893 ～0.994),两者比较无显著差异(P＞0.05).立位ARR切点为400(pg· ml-1)/(ng·ml-1·h-1)时,诊断原醛症患者的敏感性为91.9％,特异性为64.2％.结论立位ARR比卧位ARR更适应作为原醛症的筛查指标,随机ARR与立位ARR在原醛症诊断中具有相似的临床价值.本研究认为,在严格控制患者药物、体位、检测时间条件下,ARR切点400( pg·ml-1)/(ng·ml-1·h-1)是原醛症筛查试验比较合适的切点.
목적 회고분석서금의원내분비과근5년부의원발성철고동증다증환자적자료,용수시자공작특정( receiver operating characteristic,ROC)곡선하면적평고철고동/신소비치(aldosterone to renin ratio,ARR)재진단원발성철고동증다증(원철증)중적림상개치.방법 수집서금의원내분비과2006년1월지2010년8월행와위급립위ARR측정적590례부의원발성철고동증다증입원환자적림상자료,기중학진위원철증적환자357례,학진위원발성고혈압적환자233례.분석서금의원내분비과2010년9월지2011년4월행수궤급립위ARR측정적100례부의원철증환자적림상자료,기중학진위원철증적환자29례,학진위원발성고혈압적환자71례.종합분석와위、립위급수궤ARR ROC곡선,이학정합괄적절점용우진단원발성철고동증다증.결과 2006년1월지2010년8월행와위급립위ARR측정적590례환자와위ARRROC곡선하면적위0.838(0.805～0.867),립위ARR ROC곡선하면적위0.873(0.843 ～0.899),량곡선하면적비교유현저차이(P＜0.01).2010년9월지2011년4월행립위급수궤ARR측정적100례환자립위급수궤ARR ROC곡선하면적분별위0.962(0.928 ～0.995)급0.944(0.893 ～0.994),량자비교무현저차이(P＞0.05).립위ARR절점위400(pg· ml-1)/(ng·ml-1·h-1)시,진단원철증환자적민감성위91.9％,특이성위64.2％.결론 립위ARR비와위ARR경괄응작위원철증적사사지표,수궤ARR여립위ARR재원철증진단중구유상사적림상개치.본연구인위,재엄격공제환자약물、체위、검측시간조건하,ARR절점400( pg·ml-1)/(ng·ml-1·h-1)시원철증사사시험비교합괄적절점.
Objective To retrospectively analyse the data of patients with suspected primary aldosteronism (PA) during the last five years.The receiver operating characteristic (ROC) curve was used to evaluate the value of aldosterone to renin ratio (ARR) in screening primary aldosteronism.Methods The clinical data of ARR in supine and upright positions were collected in 590 patients with suspected during January 2006 to August 2010.There were 357 patients diagnosed as primary aldosteronism and 233 patients as essential hypertension among these patients.100 patients with suspected primary aldosteronism took the upright and random ARR during September 2010 to April 2011 ; Among these patients,29 patients were diagnosed as primary aldosteronism and 71 as cases of essential hypertension.ROC curve was made to retrospectively define the method and the cut-off value of the supine,upright or random ARR.Results The area under the curve(AUC) of the supine ARR in the 590 patients who took the supine and upright ARR during January 2006 to August 2010 was 0.838 (0.805-0.867 ) and the AUC of the upright ARR was 0.873 (0.843-0.899 ).There was significant difference between these two AUC readings (P＜0.01 ).The AUC in the upright ARR of the 100 patients who took the upright and random ARR during Septeuder 2010 to April 2011 was 0.962 (0.928 -0.995 ) and the AUC of the random ARR was 0.944 (0.893-0.994 ).There was no significant difference between these two AUC readings (P＞0.05).The upright ARR cutoff value with 400 ( pg · ml-1 )/( ng· ml-1 · h 1 ) yielded a sensitivity of 91.9％ and a specificity of 64.2％ to diagnosis of PA.Conclusion Upright ARR value was more suitable in the screening test than supine ARR value.Random ARR showed similar effect as the upright ARR.In our research,under strict control of the drug,position and detection time,ARR value with 400 ( pg · ml-1 )/( ng· ml-1 · h-1 ) can be the cutoff point in screening the suspcctcd PA patients.