aDepartment of Hypertension bShanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai cDepartment of Cardiology, Tongji Hospital, Tongji University dDepartment of Radiology eDepartment of Urology of Luwan Branch fDepartment of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Hypertens. 2017 Dec;35(12):2486-2492. doi: 10.1097/HJH.0000000000001488.
The current study aimed to evaluate the role of Küpers' score in predicting unilateral aldosteronism, and develop a modified score in Chinese patients with primary aldosteronism.
The current retrospective study included 406 patients with primary aldosteronism who underwent successful adrenal venous sampling (AVS) and were divided into the unilateral (n = 211) and bilateral (n = 195) groups according to the AVS results. Normokalemia was noted in both the unilateral (n = 64) and bilateral groups (n = 84) when plasma and urinary aldosterone were measured.
We evaluated Küpers' prediction score, which had the best cutoff value at four points [area under the curve, 0.601 (95% confidence interval 0.551-0.650); specificity, 53%; sensitivity, 62%]. Then, we modified this score by using urinary aldosterone level quartiles, history of hypokalemia, and typical adenoma more than 10 mm on computed tomography (CT) [area under the curve, 0.745 (95% confidence interval 0.667-0.813)]; sensitivity, 45.3%; specificity, 90.5%). The best cutoff value to discriminate unilateral from bilateral disease was a score of 5. This modified prediction score only applied to patients who were normokalemic when urinary aldosterone was measured. A specificity of 100% was achieved at a score of 6 for patients aged 40 years or less, and 5 when the adrenal lesion was on the right side on CT imaging.
Küpers' prediction score is not suitable for our patients. Urinary aldosterone levels combined with a history of hypokalemia are useful to discriminate unilateral from bilateral aldosteronism in patients with typical adenoma on the right adrenal gland on CT or in patients 40 years old or less.
本研究旨在评估 Küpers 评分在预测单侧醛固酮增多症中的作用，并为中国原发性醛固酮增多症患者建立改良评分。
本回顾性研究纳入了 406 例成功接受肾上腺静脉采样（AVS）的原发性醛固酮增多症患者，根据 AVS 结果分为单侧组（n=211）和双侧组（n=195）。当测量血浆和尿液醛固酮时，单侧组（n=64）和双侧组（n=84）均为正常血钾。
我们评估了 Küpers 预测评分，其最佳截断值为 4 分[曲线下面积为 0.601（95%置信区间为 0.551-0.650）；特异性为 53%；敏感性为 62%]。然后，我们通过使用尿醛固酮水平四分位距、低钾血症史和 CT 上大于 10mm 的典型腺瘤，对该评分进行了改良[曲线下面积为 0.745（95%置信区间为 0.667-0.813）；敏感性为 45.3%；特异性为 90.5%]。区分单侧和双侧疾病的最佳截断值为 5 分。该改良预测评分仅适用于测量尿醛固酮时血钾正常的患者。对于年龄在 40 岁或以下的患者，评分 6 时特异性达到 100%，对于 CT 上右侧肾上腺病变的患者，评分 5 时特异性达到 100%。
Küpers 预测评分不适合我们的患者。对于 CT 上右侧肾上腺有典型腺瘤或年龄在 40 岁或以下的患者，尿醛固酮水平结合低钾血症病史有助于区分单侧和双侧醛固酮增多症。
