Doi S A R, Abalkhail S, Al-Qudhaiby M M, Al-Humood K, Hafez M F, Al-Shoumer K A S
Division of Endocrinology, Mubarak Al Kabeer Teaching Hospital, Jabriya, Kuwait.
J Hum Hypertens. 2006 Jul;20(7):482-9. doi: 10.1038/sj.jhh.1002024. Epub 2006 Apr 13.
With the introduction of the aldosterone/renin ratio as a screening test, the detection rate of primary aldosteronism has increased considerably. Nevertheless, no consensus has so far been reached regarding the cutoff points, operating characteristics or indeed even the reference values for reporting the aldosterone/renin ratio using plasma active renin (ng/l or mU/l) measured by immunoradiometric assay. We review the characteristics of this ratio in normal individuals, essential hypertension and primary hyperaldosteronism in an attempt to reach an agreement regarding its optimum use and interpretation - both using the renin activity or concentration. It seems that the optimal cutoff for patients with primary aldosteronism is above 30 ng/dl per mug/l/h or 800 pmol/l per mug/l/h or 130 pmol/ng or 80 pmol/mU. We explore enhancing measures such as captopril loading or use with a plasma aldosterone cutoff as well as pitfalls with the test such as confounding medications or the need for confirmatory testing. For the latter, demonstration of autonomous aldosterone production via salt loading is widely used, but may not be most advantageous and may even be contraindicated in patients with severe hypertension. The renin stimulation test may be an alternative being safe, well tolerated, and cost effective.
随着醛固酮/肾素比值作为一种筛查试验的引入，原发性醛固酮增多症的检出率有了显著提高。然而，对于使用免疫放射分析测定的血浆活性肾素（纳克/升或毫微单位/升）来报告醛固酮/肾素比值的临界值、操作特性乃至参考值，目前尚未达成共识。我们回顾了该比值在正常个体、原发性高血压和原发性醛固酮增多症中的特征，试图就其最佳应用和解读达成一致意见——同时使用肾素活性或浓度。原发性醛固酮增多症患者的最佳临界值似乎高于每微克/升/小时30纳克/分升或每微克/升/小时800皮摩尔/升或每纳克130皮摩尔或每毫微单位80皮摩尔。我们探讨了增强措施，如卡托普利负荷试验或与血浆醛固酮临界值联合使用，以及该试验存在的问题，如混淆药物或需要进行确诊试验。对于后者，通过盐负荷试验证明醛固酮自主分泌被广泛应用，但可能并非最有利，甚至在重度高血压患者中可能是禁忌证。肾素刺激试验可能是一种替代方法，它安全、耐受性好且成本效益高。
