Yin G, Zhang S, Yan L, Wu M, Xu M, Li F, Cheng H
Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Exp Clin Endocrinol Diabetes. 2012 Jul;120(7):388-94. doi: 10.1055/s-0032-1301894. Epub 2012 Jun 11.
The serum aldosterone concentration (SAC) to plasma renin activity (PRA) ratio (ARR) is considered a useful screening test in the differential diagnosis of essential hypertension (EH) and primary aldosteronism (PA). The purpose of this study is to investigate the variation of ARR and compare the screening efficiency of it under different postures.37 patients with PA and 92 patients with EH were recruited in this study. Blood was sampled for measuring SAC and PRA under conditions of overnight recumbency, keeping upright posture for 1 h, 2 h and 4 h. The variation and screening efficiency of ARR under these conditions were compared according to repeated measured ANOVA and ROC curve analysis.In the EH group, ARR measured under recumbency posture was higher than those measured under keeping upright posture for 1 h and 2 h. In the PA group, there is no statistical difference for ARR between any 2 postures. AUCs of ARR measured under 4 conditions were 0.976, 0.995, 0.988, and 0.974 respectively. Cutoff values were ranging from 24.75 ng/dl per ng/ml/h under keeping upright for 2 h to 69.19 ng/dl per ng/ml/h under overnight recumbercy. ARR measured under keeping upright posture for 1 h produced the best characteristic of screening efficiency.Keeping upright posture for 1 h was the ideal position for ARR measuring and using a cutoff value of 35.90 ng/dl per ng/ml/h will have a sensitivity and specificity of 100.00% and 92.30% respectively.
血清醛固酮浓度（SAC）与血浆肾素活性（PRA）比值（ARR）被认为是鉴别原发性高血压（EH）和原发性醛固酮增多症（PA）的一项有用的筛查试验。本研究旨在调查ARR的变化，并比较其在不同体位下的筛查效率。本研究招募了37例PA患者和92例EH患者。在夜间卧位、直立1小时、2小时和4小时的条件下采集血样以测量SAC和PRA。根据重复测量方差分析和ROC曲线分析比较这些条件下ARR的变化和筛查效率。在EH组中，卧位测量的ARR高于直立1小时和2小时测量的ARR。在PA组中，任意两种体位下的ARR无统计学差异。4种条件下测量的ARR的AUC分别为0.976、0.995、0.988和0.974。截断值范围从直立2小时时的24.75 ng/dl per ng/ml/h到夜间卧位时的69.19 ng/dl per ng/ml/h。直立1小时测量的ARR筛查效率最佳。直立1小时是测量ARR的理想体位，使用35.90 ng/dl per ng/ml/h的截断值时，敏感性和特异性分别为100.00%和92.30%。
