不同病因高血压患者血浆肾素活性、血管紧张素Ⅱ及醛固酮水平的差异
불동병인고혈압환자혈장신소활성、혈관긴장소Ⅱ급철고동수평적차이
Differences of blood plasma renin activity, angiotensin Ⅱ and aldosterone levels in essential or secondary hypertension
  • 万方数据
    中华内科杂志 중화내과잡지
    CHINESE JOURNAL OF INTERNAL MEDICINE
    2012年 4期 294-298 ,共5页

    宋爱羚%曾正陪%童安莉%卢琳%陈适%李明%付春莉%王永慧%孙梅励

    송애령%증정배%동안리%로림%진괄%리명%부춘리%왕영혜%손매려

    高血压%醛固酮增多症%嗜铬细胞瘤%肾素-血管紧张素系统 高血壓%醛固酮增多癥%嗜鉻細胞瘤%腎素-血管緊張素繫統
    고혈압%철고동증다증%기락세포류%신소-혈관긴장소계통
    Hypertension%Hyperaldosteronism%Pheochromocytoma%Renin-angiotensin system
    目的 回顾分析并比较原发性醛固酮增多症(原醛症)、原发性高血压(EH)和嗜铬细胞瘤3种不同病因高血压患者血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮水平的差异及探讨运用醛固酮/PRA比值(ARR)的不同切点在高血压人群中筛查原醛症的敏感性和特异性.方法 采用放射免疫法测定北京协和医院内分泌科诊断的111例特发性醛固酮增多症(IHA)、118例分泌醛固酮的肾上腺皮质腺瘤(APA)、98例嗜铬细胞瘤及86例EH共计413例患者卧位及立位加速尿刺激后的血浆醛固酮、AngⅡ及PRA并计算ARR.结果 卧位及立位的血浆醛固酮水平在原醛症组[471( 346,632)pmol／L和673( 499,825) pmol/L]及嗜铬细胞瘤组[374( 294,465) pmol/L和629( 449,997)pmol／L]均高于EH组[277 (224,332) pmol/L和427( 341,501) pmol/L],P值均＜0.01,原醛症组中的APA组[576(416,731)pmol／L和726(554,906) pmol/L]高于IHA组[399(313,504)pmol／L和609(485,776)pmol／L],P＜0.01；卧位及立位的血浆AngⅡ水平在原醛症组[43.2(26.4,74.4)ng/L和60.1(38.5,103.6) ng/L]明显低于EH组[56.7(43.3,78.9)ng/L和84.3(61.3,108.4)ng/L]和嗜铬细胞瘤组[54.3(29.9,101.5) ng/L和102.8 (49.9,167.0) ng/L],P值均＜0.01,而IHA组与APA组之间差异无统计学意义；卧位及立位的血浆PRA为嗜铬细胞瘤组[0.3(0.2,1.0)μg· L-1· h-1和1.4(0.6,3.4) μg·L-1 ·h-1] ＞EH组[0.2(0.1,0.4) μg· L-1 ·h-1和0.6(0.4,1.0)μg·L-1·h-1]＞原醛症组[0.1(0.1,0.1)μg·L-1·h-1和0.2(0.1,0.3)μg· L-1 ·h-1],P值均＜0.01,而APA组[0.1(0.1,0.1)μg·L-1· h-1和0.1(0.1,0.3)μg·L-1·h-1] ＜IHA组[0.1(0.1,0.2)μg·L-1·h-1和0.2(0.1,0.3)μg· L-1·h-1](卧位P＜0.01;立位P＜0.05)；对肾素-AngⅡ有反应APA(26例)的醛固酮水平卧位低于、而立位高于肾素-AngⅡ无反应APA(92例)；立位ARR:原醛症组＞EH组(P＜0.01)＞嗜铬细胞瘤组(P＜0.05)、APA组＞IHA组(P＜0.01).立位ARR为40(醛固酮单位:ng/dl；PRA单位:μg· L-1·h-1;醛固酮单位换算为pmol/L需乘以27.7,下同)时初筛原醛症的敏感性为93％,特异性为76％.结论 醛固酮、PRA和AngⅡ水平在原醛症、EH和嗜铬细胞瘤患者中明显不同；可选择立位ARR为40作为切点在高血压患者中筛查原醛症.
    목적 회고분석병비교원발성철고동증다증(원철증)、원발성고혈압(EH)화기락세포류3충불동병인고혈압환자혈장신소활성(PRA)、혈관긴장소Ⅱ(AngⅡ)、철고동수평적차이급탐토운용철고동/PRA비치(ARR)적불동절점재고혈압인군중사사원철증적민감성화특이성.방법 채용방사면역법측정북경협화의원내분비과진단적111례특발성철고동증다증(IHA)、118례분비철고동적신상선피질선류(APA)、98례기락세포류급86례EH공계413례환자와위급립위가속뇨자격후적혈장철고동、AngⅡ급PRA병계산ARR.결과 와위급립위적혈장철고동수평재원철증조[471( 346,632)pmol／L화673( 499,825) pmol/L]급기락세포류조[374( 294,465) pmol/L화629( 449,997)pmol／L]균고우EH조[277 (224,332) pmol/L화427( 341,501) pmol/L],P치균＜0.01,원철증조중적APA조[576(416,731)pmol／L화726(554,906) pmol/L]고우IHA조[399(313,504)pmol／L화609(485,776)pmol／L],P＜0.01；와위급립위적혈장AngⅡ수평재원철증조[43.2(26.4,74.4)ng/L화60.1(38.5,103.6) ng/L]명현저우EH조[56.7(43.3,78.9)ng/L화84.3(61.3,108.4)ng/L]화기락세포류조[54.3(29.9,101.5) ng/L화102.8 (49.9,167.0) ng/L],P치균＜0.01,이IHA조여APA조지간차이무통계학의의；와위급립위적혈장PRA위기락세포류조[0.3(0.2,1.0)μg· L-1· h-1화1.4(0.6,3.4) μg·L-1 ·h-1] ＞EH조[0.2(0.1,0.4) μg· L-1 ·h-1화0.6(0.4,1.0)μg·L-1·h-1]＞원철증조[0.1(0.1,0.1)μg·L-1·h-1화0.2(0.1,0.3)μg· L-1 ·h-1],P치균＜0.01,이APA조[0.1(0.1,0.1)μg·L-1· h-1화0.1(0.1,0.3)μg·L-1·h-1] ＜IHA조[0.1(0.1,0.2)μg·L-1·h-1화0.2(0.1,0.3)μg· L-1·h-1](와위P＜0.01;립위P＜0.05)；대신소-AngⅡ유반응APA(26례)적철고동수평와위저우、이립위고우신소-AngⅡ무반응APA(92례)；립위ARR:원철증조＞EH조(P＜0.01)＞기락세포류조(P＜0.05)、APA조＞IHA조(P＜0.01).립위ARR위40(철고동단위:ng/dl；PRA단위:μg· L-1·h-1;철고동단위환산위pmol/L수승이27.7,하동)시초사원철증적민감성위93％,특이성위76％.결론 철고동、PRA화AngⅡ수평재원철증、EH화기락세포류환자중명현불동；가선택립위ARR위40작위절점재고혈압환자중사사원철증.
    Objective To study on the difference of plasma renin activity ( PRA),angiotensin Ⅱ (Ang Ⅱ ),and aldosterone levels in patients with essential hypertension (EH) or primary aldosteronism (PA) or pheochromocytoma (PHEO),and to analyze the sensitivity and specificity on the diagnosis of PA among patients with hypertension with aldosterone/PRA ratio (ARR).Methods The plasma aldosterone,Ang Ⅱ and PRA concentrations in supine and upright positions were measured by radioimmunoassay from 413 patients including idiopathic hyperaldosteronism (IHA,n =111 ),aldosterone-producing adenoma (APA,n=l18),PHEO (n=98) and EH (n=86).ARR was calculated.Results Plasma aldosterone concentrations in both of supine and upright positions in PHEO group [ 374 (294,465 ) pmol/L and 629 (449,997) pmol/L] and PA group [471 (346,632) pmol/L and 673(499,825) pmol/L] were higher than those in EH group [ 277 (224,332) pmol/L and 427 (341,501 ) pmol/L ] (P ＜ 0.01 ).They were also higher in APA group [576 (416,731 ) pmol/L and 726 (554,906 )pmol/L ] than those in IHA group [399(313,504) pmol/L and 609(485,776)pmol/L ] (P ＜0.01).Ang Ⅱ levels in both positions were lower in PA group [43.2(26.4,74.4) ng/L and 60.1(38.5,103.6) ng/L] than in EH group [56.7 (43.3,78.9) ng/L and 84.3(61.3,108.4) ng/L] or PHEO group [54.3(29.9,101.5) ng/L and 102.8 (49.9,167.0) ng/L] (all P values ＜ 0.01 ),and there was no difference between IHA and APA group (P ＞ 0.05 ).The PRA level in both positions of each group were PHEO group [ 0.3 (0.2,1.0) μg ·L-1 · h-1 and 1.4(0.6,3.4) μg · L-1 · h-1] ＞EH group [0.2(0.1,0.4)μg · L-1 · h-1 and 0.6(0.4,1.0)μg· L-1 ·h-1] (P＜0.01) ＞PAgroup [0.1(0.1,0.1)μg· L-1 · h-1 and 0.2(0.1,0.3)μg·L-1 · h-1] (P＜0.01),and APA group [0.1(0.1,0.1)μg · L-1 · h-1 and0.1(0.1,0.3)μg · L-1 ·h - 1 ] ＜ IHA group [ 0.1 ( 0.1,0.2 ) μg · L - 1 · h - 1 and 0.2 (0.1,0.3 ) μg · L-1 · h - 1 ] ( supine P ＜0.01 ; upright P ＜ 0.05 ).APA was divided into 2 types with renin-Ang Ⅱ -responsive APA ( n =26) and unresponsive APA (n =92).The plasma aldosterone concentration was lower in supine position but higher in upright position in renin-Ang Ⅱ-responsive APA than in unresponsive APA patients.ARR in upright was higher in PA group ( P ＜ 0.01 ) but lower in PHEO group ( P ＜ 0.05 ) compared with EH.ARR was higher in APA than in IHA (P ＜0.01 ).The sensitivity and specificity of ARR as 40 (aldosterone unit:ng/dl;PRA unit:μg · L-1 · h-1; its value should multiply 27.7 when transferred to pmol/L,simili) were 93％ and 76％,respectively.Conclusion The levels of PRA,Ang Ⅱ and aldosterone from patients with EH,PA and PHEO are significant different.ARR as 40 in upright position could be used for PA screening cutoff point.
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