血浆肾素活性和醛固酮水平作为一种筛选试验，用于区分高血压患者单侧和双侧肾动脉狭窄是否有用？

Are plasma renin activity and aldosterone levels useful as a screening test to differentiate between unilateral and bilateral renal artery stenosis in hypertensive patients?

机构信息

Centro de Hipertensión Arterial, Hospital Universitario Austral, Buenos Aires, Argentina.

出版信息

J Hypertens. 2010 Mar;28(3):594-601. doi: 10.1097/HJH.0b013e32833487d4.

DOI:10.1097/HJH.0b013e32833487d4

PMID:20104188

Abstract

OBJECTIVE

To evaluate the serum aldosterone (Ald)/plasmatic renin activity (PRA) ratio as a surrogate marker of renin-angiotensin-aldosterone system status in unilateral (Uni)- and bilateral (Bi)-renal artery stenosis (RAS).

METHODS

Seven hundred and eight hypertensive patients (HTP) were studied. Intermediate and high pretest risk of RAS was detected in 66 HTP who subsequently underwent renal gadolinium-enhanced magnetic resonance and arteriography. After application of exclusion criteria 51 HTP remained: 16 with Uni-RAS, 16 with Bi-RAS and 19 essential hypertensives with normal arteries. Nineteen normotensive individuals were also studied. Ald and PRA were determined before and after stenosis resolution by balloon angioplasty and stent implantation.

RESULTS

Ald/PRA (ng/dl per (ng/ml per h(-1))) was markedly high in Bi-RAS (5.92 +/- 2.30, P < 0.001), and markedly low in Uni-RAS (0.38 +/- 0.17, P < 0.001) versus essential hypertensives (1.52 +/- 2.02). Multilevel likelihood ratios for Bi-RAS were positive for Ald/PRA higher than 3.6, negative for Ald/PRA lower than 0.2, and neutral for Ald/PRA at least 0.2 and 3.6 or less. ROC analysis identified Ald/PRA lower than 0.5 and Ald/PRA higher than 3.7 to have the best sensitivity and specificity to detect Uni-RAS and Bi-RAS, respectively. In Uni-RAS, but not in Bi-RAS, postinterventional PRA was significantly lower than basal PRA. In Uni-RAS and Bi-RAS, postinterventional Ald was approximately 30% and approximately three times lower than basal Ald, respectively. In essential hypertensives, PRA and Ald showed no changes in the same period.

CONCLUSION

In the population studied, Ald, PRA and Ald/PRA were significantly different among essential hypertensives, and HTP with Uni-RAS or Bi-RAS. Studies with a higher number of patients will allow exploration of the usefulness of pharmacologic aldosterone blockade in Bi-RAS, and to assess the relevance of Ald/PRA to differentiate Uni-RAS from Bi-RAS.

摘要

目的

评估血清醛固酮（Ald）/血浆肾素活性（PRA）比值作为单侧（Uni）和双侧（Bi）肾动脉狭窄（RAS）肾素-血管紧张素-醛固酮系统状态的替代标志物。

方法

研究了 708 例高血压患者（HTP）。在随后接受肾钆增强磁共振和血管造影的 66 例 HTP 中，检测到中等和高的 RAS 术前风险。应用排除标准后，仍有 51 例 HTP 患者：16 例单侧 RAS、16 例双侧 RAS 和 19 例正常动脉的原发性高血压。还研究了 19 例正常血压个体。通过球囊血管成形术和支架植入术解除狭窄后，测定 Ald 和 PRA。

结果

Bi-RAS 的 Ald/PRA（ng/dl 每（ng/ml 每 h））明显高于原发性高血压（5.92 +/- 2.30，P < 0.001），明显低于 Uni-RAS（0.38 +/- 0.17，P < 0.001）。Bi-RAS 的多水平似然比对 Ald/PRA 大于 3.6 为阳性，对 Ald/PRA 小于 0.2 为阴性，对 Ald/PRA 至少 0.2 和 3.6 或更低为中性。ROC 分析确定 Ald/PRA 小于 0.5 和 Ald/PRA 大于 3.7 分别对检测 Uni-RAS 和 Bi-RAS 具有最佳的灵敏度和特异性。在 Uni-RAS 中，但不在 Bi-RAS 中，介入后 PRA 明显低于基础 PRA。在 Uni-RAS 和 Bi-RAS 中，介入后 Ald 分别约为基础 Ald 的 30%和约三倍，分别约为基础 Ald 的 30%和约三倍。在原发性高血压患者中，同一时期 PRA 和 Ald 无变化。