Montori Victor M, Young William F
Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic Rochester, 200 First Street Southwest, Rochester, MN 55905, USA.
Endocrinol Metab Clin North Am. 2002 Sep;31(3):619-32, xi. doi: 10.1016/s0889-8529(02)00013-0.
The aldosterone-renin ratio is widely used to screen for primary aldosteronism. We conducted a systematic review of the literature to establish the test characteristics (sensitivity, specificity, likelihood ratios at different cutoff values) of the aldosterone-renin ratio used in screening for primary aldosteronism in subjects with presumed essential hypertension. We searched Medline, EMBASE, and Current Contents databases, bibliographies of retrieved papers, and personal files for all reports published from January 1966 to October 2001. We consulted experts to identify additional published and unpublished reports. We included prospective studies of the ratio as a screening test for primary aldosteronism, without applying language or data availability restrictions. We excluded retrospective studies, case reports, and duplicate or preliminary reports. Working independently, we selected the articles, assessed their quality, and extracted their data. Data extracted included sample size and care setting, description of the testing conditions, description of the confirmatory tests, and the test characteristics of the ratio (sensitivity, specificity, likelihood ratios at different cutoff values). This review includes 16 studies with 3136 participants. None of the studies evaluated the aldosterone-renin ratio and the reference standard independently of each other; only two studies evaluated patients who had a "negative" ratio with the reference standard. Only 16.7% of the subjects had both the ratio and the confirmatory test performed. Ratio cutoff values ranged from 200 to 2774 pmol/L per ng/mL per hour. None of the studies provided valid estimates of the aldosterone-renin ratio test characteristics. There are no published valid estimates of the test characteristics of the aldosterone-renin ratio when used as a screening test for primary aldosteronism in patients with presumed essential hypertension.
醛固酮-肾素比值被广泛用于原发性醛固酮增多症的筛查。我们对文献进行了系统综述，以确定在疑似原发性高血压患者中用于筛查原发性醛固酮增多症的醛固酮-肾素比值的检测特征（敏感性、特异性、不同临界值下的似然比）。我们检索了1966年1月至2001年10月发表的所有报告的Medline、EMBASE和《现刊目次》数据库、检索论文的参考文献以及个人文档。我们咨询专家以确定其他已发表和未发表的报告。我们纳入了将该比值作为原发性醛固酮增多症筛查试验的前瞻性研究，未施加语言或数据可得性限制。我们排除了回顾性研究、病例报告以及重复或初步报告。我们独立筛选文章、评估其质量并提取数据。提取的数据包括样本量和护理环境、检测条件描述、确诊试验描述以及该比值的检测特征（敏感性、特异性、不同临界值下的似然比）。本综述纳入了16项研究，共3136名参与者。没有一项研究独立评估醛固酮-肾素比值和参考标准；只有两项研究评估了参考标准下“阴性”比值的患者。只有16.7%的受试者同时进行了该比值和确诊试验。比值临界值范围为每小时每纳克/毫升200至2774皮摩尔/升。没有一项研究提供醛固酮-肾素比值检测特征的有效估计值。在疑似原发性高血压患者中，当醛固酮-肾素比值用作原发性醛固酮增多症的筛查试验时，目前尚无已发表的该比值检测特征的有效估计值。
