Medizinische Klinik Innenstadt der Ludwig-Maximilians-Universität, München, Germany.
Horm Metab Res. 2010 Jun;42(6):400-5. doi: 10.1055/s-0030-1248287. Epub 2010 Mar 9.
Recent evidence demonstrates an increased incidence of primary aldosteronism (PA) in approximately 10% of the hypertensive population, making noninvasive and simple screening methods necessary. The aim of the present study was to apply a time-resolved fluorescence immunoassay for the measurement of aldosterone in saliva and the establishment of a cut-off to identify patients with a high likelihood for PA requiring subsequent screening with the aldosterone to renin ratio. Saliva was collected (AM and PM) to ascertain an optimum time with best discriminating power between healthy and disease states. Plasma aldosterone, after overnight recumbency and 4 h later, was collected for posture testing. The participants included 53 PA patients (aged 14-78), 54 with essential hypertension (EH, aged 19-82), and 38 healthy volunteers (aged 19-56). Saliva aldosterone (SA) (median, 25-75(th)%) in PA was found at 90 pg/ml (61-139) compared to 53 pg/ml (40-85) in EH, with discrimination between PA versus EHs best in the morning (cutoff: 81 pg/ml, 77% sensitivity, 82% specificity). Saliva aldosterone decreases throughout the day in patients with adenomas [APA AM: 123 pg/ml (92-213) vs. PM: 79 pg/ml (41-116)], but not in those with bilateral hyperplasia [BAH AM: 85 pg/ml (59-115)] vs. pm 69 pg/ml (57-114). Morning SA alone allows discrimination between PA and controls, though with significant overlap against EHs, leading to a high number of false positives. More promising is the use of diurnal variation in SA in distinguishing between APA and BAH. The decline in SA seen in patients with APA presents a more constant finding compared to posture testing, which fails to correctly classify a large number of patients.
最近的证据表明，原发性醛固酮增多症（PA）在大约 10%的高血压人群中的发病率增加，因此需要进行非侵入性和简单的筛查方法。本研究的目的是应用时间分辨荧光免疫分析法测量唾液中的醛固酮，并建立一个切点来识别具有高可能性患有 PA 的患者，这些患者需要进一步进行醛固酮与肾素比值筛查。收集唾液（上午和下午）以确定最佳时间，以便在健康状态和疾病状态之间具有最佳的区分能力。采集过夜卧床后 4 小时的血浆醛固酮进行体位试验。参与者包括 53 名 PA 患者（年龄 14-78 岁）、54 名原发性高血压患者（EH，年龄 19-82 岁）和 38 名健康志愿者（年龄 19-56 岁）。PA 患者的唾液醛固酮（SA）（中位数，25-75%）为 90pg/ml（61-139），EH 患者为 53pg/ml（40-85），PA 与 EH 之间的区分在上午最佳（切点：81pg/ml，77%敏感性，82%特异性）。腺瘤患者的唾液醛固酮（SA）全天下降[APA 上午：123pg/ml（92-213）与下午：79pg/ml（41-116）]，但双侧增生患者的唾液醛固酮（SA）没有下降[BAH 上午：85pg/ml（59-115）与下午：69pg/ml（57-114）]。仅上午的 SA 即可区分 PA 和对照组，尽管与 EH 有明显重叠，导致大量假阳性。更有希望的是使用 SA 的昼夜变化来区分 APA 和 BAH。与体位试验相比，APA 患者的 SA 下降是一个更稳定的发现，因为体位试验未能正确分类大量患者。
