DMCS-Internal Medicine 4, University Hospital, Padova, Italy.
J Hypertens. 2010 Sep;28(9):1892-9. doi: 10.1097/HJH.0b013e32833d2192.
The screening for primary aldosteronism is based on the aldosterone-renin ratio calculated with the plasma renin activity (PRA) value as denominator. A direct measurement of active renin (DRA) is being used as an alternative to PRA, but its diagnostic performance remains unclear.
We, therefore compared, head-to-head, the aldosterone-renin ratio based on PRA with that based on DRA, at baseline and after captopril administration, for identifying aldosterone-producing adenoma (APA) in 251 patients of the Primary Aldosteronism Prevalence in hYpertension Study (PAPY). The area under the receiver operator characteristics curves was used for estimating the accuracy of the aldosterone-renin ratio based on either renin assay for identifying APA and for the comparison between tests.
The rate of primary aldosteronism was 13.2%; 6.4% of the patients had an APA and 6.8% idiopathic hyperaldosteronism; 218 (86.8%) had primary hypertension. The area under the receiver operator characteristics curve for identifying APA was higher than 0.50 for the aldosterone-renin ratio based on both renin values (0.870 +/- 0.058 for DRA and 0.973 +/- 0.028 for PRA) (P < 0.0001 for both) and did not differ significantly between the aldosterone-renin ratios calculated with either renin assay. For the aldosterone-renin ratio based on DRA, the optimal cutoff value for identifying APA was 27.3 ng/mIU, remarkably similar to that previously determined for the aldosterone-renin ratio based on PRA.
Thus, the aldosterone-renin ratio based on DRA is a valuable alternative to that based on PRA for detecting APA.
原发性醛固酮增多症的筛查基于以血浆肾素活性（PRA）值为分母计算的醛固酮-肾素比值。目前正在使用活性肾素（DRA）的直接测量值作为 PRA 的替代方法，但它的诊断性能仍不清楚。
因此，我们在原发性醛固酮增多症患病率研究（PAPY）的 251 例患者中，直接比较了基于 PRA 的醛固酮-肾素比值和基于 DRA 的醛固酮-肾素比值，以确定醛固酮瘤（APA）。接受者操作特征曲线下的面积用于估计基于任何一种肾素检测的醛固酮-肾素比值用于识别 APA 的准确性，以及用于测试之间的比较。
原发性醛固酮增多症的发生率为 13.2%；6.4%的患者存在 APA，6.8%的患者存在特发性醛固酮增多症；218 例（86.8%）患有原发性高血压。用于识别 APA 的接受者操作特征曲线下的面积大于基于两种肾素值的醛固酮-肾素比值的 0.50（DRA 为 0.870 +/- 0.058，PRA 为 0.973 +/- 0.028）（两者均 P < 0.0001），并且基于两种肾素检测的醛固酮-肾素比值之间没有显著差异。对于基于 DRA 的醛固酮-肾素比值，用于识别 APA 的最佳截断值为 27.3ng/mIU，与之前基于 PRA 的醛固酮-肾素比值确定的截断值非常相似。
因此，基于 DRA 的醛固酮-肾素比值是检测 APA 的一种有价值的 PRA 替代方法。
