Rye Peter, Chin Alex, Pasieka Janice, So Benny, Harvey Adrian, Kline Gregory
Department of Medicine, University of Calgary, Calgary, AB.
Calgary Laboratory Services, Department of Pathology and Laboratory Medicine, Section of Clinical Biochemistry, University of Calgary, Calgary, AB.
J Clin Hypertens (Greenwich). 2015 Jul;17(7):541-6. doi: 10.1111/jch.12523. Epub 2015 Mar 10.
The authors sought to define the 95th percentile of plasma renin activity (PRA) in a sample of patients with confirmed primary aldosteronism (PA) prior to adjustment of medications as a practical "first-look" test to identify those with very low ultimate likelihood of having PA. The aldosterone to renin ratio (ARR) was measured without adjustment of antihypertensive medications, with further workup as appropriate. Two groups were defined: patients with surgically "confirmed PA" (n=58) and patients with "high-probability PA" (n=59), defined as having any of the following: computed tomography-confirmed adrenal adenoma plus lateralizing adrenal vein sampling (AVS) without surgery, high ARR and hypokalemia but nonlateralizing AVS, or ARR more than four times the upper limit of normal. The PRA 95th percentile was 1.0 ng/mL/h. All outliers had hypokalemia and two had adrenal adenomas. There was no difference between the confirmed and high probability groups. In the absence of highly suspicious clinical features, patients with unadjusted PRA >1.0 ng/mL/h do not warrant further investigation for PA.
作者试图在确诊为原发性醛固酮增多症（PA）的患者样本中，确定未调整药物治疗前血浆肾素活性（PRA）的第95百分位数，作为一种实用的“初步”检测方法，以识别那些最终患PA可能性极低的患者。在未调整抗高血压药物的情况下测量醛固酮与肾素比值（ARR），并根据情况进行进一步检查。定义了两组：手术“确诊PA”的患者（n = 58）和“高概率PA”的患者（n = 59），“高概率PA”定义为具有以下任何一种情况：计算机断层扫描确诊的肾上腺腺瘤加上未手术的肾上腺静脉采样（AVS）定位、ARR高且低钾血症但AVS未定位，或ARR超过正常上限的四倍。PRA的第95百分位数为1.0 ng/mL/h。所有异常值均有低钾血症，其中两例有肾上腺腺瘤。确诊组和高概率组之间无差异。在没有高度可疑临床特征的情况下，未调整的PRA>1.0 ng/mL/h的患者无需进一步进行PA检查。
