Fradley Michael, Liu Jeffrey, Atta Mohamed G
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
Am J Ther. 2005 Jul-Aug;12(4):368-74. doi: 10.1097/01.mjt.0000147450.06270.6a.
Primary aldosteronism (PA) was initially thought to be a rare cause of hypertension. Currently, the screening modality for PA in patients with presumed secondary hypertension is the aldosterone:renin ratio (ARR). Since the advent of the ARR, the prevalence rates of PA have increased dramatically in the general population. Recently however, several reviews have suggested flaws in the ARR, leading to a possible overestimation of the prevalence of this disease. Within the HIV-positive population, there are few documented cases of PA however. With the increasing reliance on the ARR to screen and diagnose this disorder, this number is likely to rise. It is now known that the HIV has rennin-like properties. Therefore, HIV infection itself can inappropriately alter the ARR. Additionally, the medication used to treat HIV infection can also affect this value. Although the ARR is a convenient tool for screening patients with possible PA, there are multiple associated concerns particularly when it is applied to the HIV-positive population. Therefore, further testing is essential in all HIV-positive patients in whom PA is suspected.
原发性醛固酮增多症（PA）最初被认为是高血压的罕见病因。目前，对于疑似继发性高血压患者，PA的筛查方式是醛固酮与肾素比值（ARR）。自ARR问世以来，普通人群中PA的患病率急剧上升。然而，最近有几项综述指出了ARR存在的缺陷，可能导致对该疾病患病率的高估。在HIV阳性人群中，PA的病例记录很少。随着越来越依赖ARR来筛查和诊断这种疾病，这一数字可能会上升。现在已知HIV具有类似肾素的特性。因此，HIV感染本身可不适当地改变ARR。此外，用于治疗HIV感染的药物也会影响该值。尽管ARR是筛查可能患有PA患者的便捷工具，但存在多个相关问题，尤其是应用于HIV阳性人群时。因此，对于所有疑似PA的HIV阳性患者，进一步检测至关重要。
