军事医学
軍事醫學
군사의학
BULLETIN OF THE ACADEMY OF MILITARY MEDICAL SCIENCES
2015年
4期
279-283
,共5页
孙明芳%杨珊%何小群%周波%李启富%段雅倩
孫明芳%楊珊%何小群%週波%李啟富%段雅倩
손명방%양산%하소군%주파%리계부%단아천
血浆醛固酮浓度%血浆肾素浓度%原发性醛固酮增多症%筛查试验
血漿醛固酮濃度%血漿腎素濃度%原髮性醛固酮增多癥%篩查試驗
혈장철고동농도%혈장신소농도%원발성철고동증다증%사사시험
plasma aldosterone concentration%plasma renin concentration%primary aldosteronism%screening test
目的：探讨最适于临床筛查原发性醛固酮增多症（ PA）的方案。方法收集疑诊PA的病例303例，分为PA组、原发性高血压组和无功能性肾上腺皮质意外瘤组。利用血浆醛固酮／肾素浓度比值（ ARR）绘制受试者工作特征（ ROC）曲线，获取最佳诊断界值。进一步对目前临床关于PA筛查的方案进行对比分析。结果立位ARR的ROC曲线下面积明显高于卧位ARR及立、卧位血浆肾素、醛固酮。立位ARR诊断PA的最佳诊断界值[（ pg／ml ）／（μIU／ml）]为43．45，两次立、卧位试验中至少一次立位ARR ＞43．45时诊断PA的灵敏度最高，达0．94；两次立位ARR均＜43．45时，其除外PA的灵敏度为0．74，特异度为0．94，准确度为0．81。结论在高危人群中筛查PA，推荐行两次立位血浆肾素、醛固酮浓度测定，在两次中只要有一次立位ARR＞43．45即需考虑PA可能，并进一步进行确诊试验以避免漏诊。
目的：探討最適于臨床篩查原髮性醛固酮增多癥（ PA）的方案。方法收集疑診PA的病例303例，分為PA組、原髮性高血壓組和無功能性腎上腺皮質意外瘤組。利用血漿醛固酮／腎素濃度比值（ ARR）繪製受試者工作特徵（ ROC）麯線，穫取最佳診斷界值。進一步對目前臨床關于PA篩查的方案進行對比分析。結果立位ARR的ROC麯線下麵積明顯高于臥位ARR及立、臥位血漿腎素、醛固酮。立位ARR診斷PA的最佳診斷界值[（ pg／ml ）／（μIU／ml）]為43．45，兩次立、臥位試驗中至少一次立位ARR ＞43．45時診斷PA的靈敏度最高，達0．94；兩次立位ARR均＜43．45時，其除外PA的靈敏度為0．74，特異度為0．94，準確度為0．81。結論在高危人群中篩查PA，推薦行兩次立位血漿腎素、醛固酮濃度測定，在兩次中隻要有一次立位ARR＞43．45即需攷慮PA可能，併進一步進行確診試驗以避免漏診。
목적：탐토최괄우림상사사원발성철고동증다증（ PA）적방안。방법수집의진PA적병례303례，분위PA조、원발성고혈압조화무공능성신상선피질의외류조。이용혈장철고동／신소농도비치（ ARR）회제수시자공작특정（ ROC）곡선，획취최가진단계치。진일보대목전림상관우PA사사적방안진행대비분석。결과립위ARR적ROC곡선하면적명현고우와위ARR급립、와위혈장신소、철고동。립위ARR진단PA적최가진단계치[（ pg／ml ）／（μIU／ml）]위43．45，량차립、와위시험중지소일차립위ARR ＞43．45시진단PA적령민도최고，체0．94；량차립위ARR균＜43．45시，기제외PA적령민도위0．74，특이도위0．94，준학도위0．81。결론재고위인군중사사PA，추천행량차립위혈장신소、철고동농도측정，재량차중지요유일차립위ARR＞43．45즉수고필PA가능，병진일보진행학진시험이피면루진。
Objective To explore the best way for clinical screening of primary aldosteronism (PA).Methods Three hundred and three suspected cases of PA were collected and divided into groups of primary aldosteronism group, essential hypertension group, and nonsecreting cortical adrenal tumor group.The plasma aldosterone concentration/plasma renin concentration ratio ( ARR) was used to draw the receiver operating characteristic ( ROC) curve and obtain the best cut-off point.Furthermore, the current screening schemes for PA were compared.Results Upright ARR yield had larger areas under the ROC curve than plasma aldosterone concentration or plasma renin concentration under all conditions of testing. The best cut-off point of upright ARR[(pg/ml)/(μIU/ml)] for the diagnosis of PA was 43.45.During the two postural stimulation tests,the two upright ARR exceeded 43.45 with the highest diagnostic sensitivity of PA reaching 0.94.During the two upright tests ARR was less than 43.45, with a sensitivity of 0.74, and a specificity of 0.94.Conclusion To screen for PA in high-risk populations, twice postural stimulation test is recommended.As long as the upright ARR is above 43.45, PA may be considered and further confirmation is needed to prevent misdiagnosis.
