Eugenio Russmann María Laura, Delfino Laura, Fierro Fabiana, Santoro Silvina, Peréz Mariana, Caruso Gustavo, Glikman Patricia, Gauna Alicia, Lupi Susana
Servicio de Endocrinología, Hospital José María Ramos Mejía, Ciudad de Buenos Aires, Argentina.
Servicio de Endocrinología, Hospital José María Ramos Mejía, Ciudad de Buenos Aires, Argentina.
Endocrinol Diabetes Nutr (Engl Ed). 2019 Jun-Jul;66(6):361-367. doi: 10.1016/j.endinu.2018.11.008. Epub 2019 Feb 5.
Primary aldosteronism (PA) is the most common cause of endocrine hypertension, with a prevalence rate of 6-12% in hypertensive patients. Aldosterone/renin ratio (ARR) is the screening test of choice for PA. Because of the variable cut-off points of ARR, reference values related to the populations and methods considered are recommended.
(i)To optimize the ARR cut-off points for PA screening with current methods; (ii)to assess the correlation and diagnostic sensitivity of the plasma aldosterone concentration/plasma renin activity (ARR) ratio and the aldosterone concentration/renin concentration (ARC) ratios for PA screening, and (iii)to determine the prevalence of PA in our population.
Plasma aldosterone concentration and plasma renin activity levels were measured using radioimmunoassays (RIAZENco Zentech and RIA DiaSorin respectively), while a chemiluminescence assay (Liaison Diasorin) was used to test renin concentration. ARR and ARC ratios were calculated in 345 subjects (136 healthy subjects and 209 hypertensive patients).
Prevalence of PA was 5.9% after diagnostic confirmation. ROC curve analysis suggested an ARR threshold of 48.9(ng/dL)/(ng/mL/h) (100% sensitivity, 93.6% specificity) and an ARC threshold of 2.3(ng/dL)/(μIU/mL) (100% sensitivity, 90.9% specificity). Good correlation was seen between ARR and ARC (ρ=.83, P<.0001), with a presumptive diagnostic concordance of 96.6%.
New cut-off values of ARR and ARC for screening of PA, with high sensitivity and good diagnostic concordance, were determined in the study population. It is important to have valid normal ranges to avoid diagnostic errors.
原发性醛固酮增多症（PA）是内分泌性高血压最常见的病因，在高血压患者中的患病率为6%-12%。醛固酮/肾素比值（ARR）是PA的首选筛查试验。由于ARR的截断点存在差异，因此建议使用与所考虑的人群和方法相关的参考值。
（i）用现有方法优化PA筛查的ARR截断点；（ii）评估血浆醛固酮浓度/血浆肾素活性（ARR）比值和醛固酮浓度/肾素浓度（ARC）比值在PA筛查中的相关性和诊断敏感性，以及（iii）确定我们人群中PA的患病率。
分别使用放射免疫分析法（RIAZENco Zentech和RIA DiaSorin）测量血浆醛固酮浓度和血浆肾素活性水平，同时使用化学发光分析法（Liaison Diasorin）检测肾素浓度。计算了345名受试者（136名健康受试者和209名高血压患者）的ARR和ARC比值。
诊断确认后PA的患病率为5.9%。ROC曲线分析表明，ARR阈值为48.9（ng/dL）/（ng/mL/h）（敏感性100%，特异性93.6%），ARC阈值为2.3（ng/dL）/（μIU/mL）（敏感性100%，特异性90.9%）。ARR与ARC之间存在良好的相关性（ρ = .83，P < .0001），推定诊断一致性为96.6%。
本研究人群确定了用于PA筛查的ARR和ARC的新截断值，具有高敏感性和良好的诊断一致性。拥有有效的正常范围以避免诊断错误很重要。
