Division of Cardiology and Nephrology, Department of Internal Medicine, JR Sapporo Hospital.
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo.
J Hypertens. 2018 Feb;36(2):326-334. doi: 10.1097/HJH.0000000000001511.
To develop and validate a scoring system for selection of patients who should proceed to endocrinologic examinations of primary aldosteronism in newly diagnosed hypertensive patients.
A multivariate logistic regression analysis for primary aldosteronism was undertaken by use of seven possible primary aldosteronism markers, age less than 40 years, female sex, moderate-to-severe hypertension, hypokalemia, serum Na minus Cl at least 40 mmol/l, serum uric acid 237.92 μmol/l or less (4.0 mg/dl), and urine pH (U-pH) at least 7.0, in consecutive outpatients newly diagnosed with hypertension. The diagnostic criteria of primary aldosteronism were plasma aldosterone concentration-to-plasma renin activity ratio [ARR, (ng/dl)/(ng/ml per h)] at least 20 and at least one positive result in four types of challenge tests.
Of 130 patients, 24 were diagnosed with primary aldosteronism. The area under the receiver operating characteristic curve (AUC) for a logistic model incorporating all possible primary aldosteronism markers was 0.73 [95% confidence interval (CI): 0.61-0.85]. Removing high U-pH, female sex, and hypokalemia from the full model decreased the AUC by 0.059, 0.035, and 0.011, respectively. We devised pH of urine, female sex, low serum K (PFK) score, in which one point each was assigned to high U-pH, female sex, and hypokalemia. The prevalences of primary aldosteronism in patients with 0, 1, 2, and 3 points were 11, 14, 42, and 60%, respectively. In external validation datasets (n = 106), AUC of PFK score was significantly higher than that of hypokalemia alone (0.73, 95% CI: 0.63-0.83 vs. 0.53, 95% CI: 0.44-0.63, P < 0.01).
PFK score may be a better parameter than hypokalemia alone for identifying patients with a high probability of having primary aldosteronism.
建立并验证一个评分系统，用于选择新诊断的高血压患者中应进行原发性醛固酮增多症内分泌检查的患者。
对连续新诊断的高血压门诊患者，采用多元逻辑回归分析，对 7 个可能的原发性醛固酮增多症标志物（年龄<40 岁、女性、中重度高血压、低钾血症、血清 Na- Cl 至少 40mmol/l、血清尿酸 237.92μmol/l 或更低（4.0mg/dl）、U-pH 至少 7.0）进行原发性醛固酮增多症的多变量逻辑回归分析。原发性醛固酮增多症的诊断标准为血浆醛固酮浓度-血浆肾素活性比值[ARR，（ng/dl）/（ng/ml per h）]至少 20 且四种类型的激发试验至少有一个阳性结果。
在 130 例患者中，有 24 例被诊断为原发性醛固酮增多症。纳入所有可能的原发性醛固酮增多症标志物的逻辑模型的受试者工作特征曲线（AUC）下面积为 0.73[95%置信区间（CI）：0.61-0.85]。从全模型中去除高 U-pH、女性和低钾血症后，AUC 分别降低了 0.059、0.035 和 0.011。我们设计了尿 pH、女性和低血清钾（PFK）评分，高 U-pH、女性和低钾血症各得 1 分。0、1、2 和 3 分的患者中原发性醛固酮增多症的患病率分别为 11%、14%、42%和 60%。在外部验证数据集中（n=106），PFK 评分的 AUC 明显高于低钾血症（0.73，95%CI：0.63-0.83 与 0.53，95%CI：0.44-0.63，P<0.01）。
PFK 评分可能是比低钾血症更适合识别原发性醛固酮增多症可能性较高的患者的参数。
