基础血浆醛固酮水平和肾素活性可排除原发性醛固酮增多症的确认性检查。

Baseline Plasma Aldosterone Level and Renin Activity Allowing Omission of Confirmatory Testing in Primary Aldosteronism.

机构信息

Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.

Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.

出版信息

J Clin Endocrinol Metab. 2020 May 1;105(5). doi: 10.1210/clinem/dgaa117.

DOI:10.1210/clinem/dgaa117

PMID:32157288

Abstract

CONTEXT

Previous studies have proposed cutoff value of baseline plasma aldosterone concentration (bPAC) under renin suppression that could diagnose primary aldosteronism (PA) without confirmatory testing. However, those studies are limited by selection bias due to a small number of patients and a single-center study design.

OBJECTIVE

This study aimed to determine cutoff value of bPAC and baseline plasma renin activity (bPRA) for predicting positive results in confirmatory tests for PA.

DESIGN

The multi-institutional, retrospective, cohort study was conducted using the PA registry in Japan (JPAS/JRAS). We compared bPAC in patients with PA who showed positive and negative captopril challenge test (CCT) or saline infusion test (SIT) results.

PATIENTS

Patients with PA who underwent CCT (n = 2256) and/or SIT (n = 1184) were studied.

MAIN OUTCOME MEASURES

The main outcomes were cutoff value of bPAC (ng/dL) and bPRA (ng/mL/h) for predicting positive CCT and/or SIT results.

RESULTS

In patients with renin suppression (bPRA ≤ 0.3), the cutoff value of bPAC that would give 100% specificity for predicting a positive SIT result was lower than that for predicting a positive CCT result (30.85 vs 56.35, respectively). Specificities of bPAC cutoff values ≥ 30.85 for predicting positive SIT and CCT results remained high (100.0% and 97.0%, respectively) in patients with bPRA ≤ 0.6. However, the specificities of bPAC cutoff values ≥ 30.85 for predicting positive SIT and CCT results decreased when patients with bPRA > 0.6 were included.

CONCLUSION

Confirmatory testing could be omitted in patients with bPAC ≥ 30.85 in the presence of bPRA ≤ 0.6.

摘要

背景

先前的研究提出了在肾素抑制下的基础血浆醛固酮浓度（bPAC）的截断值，该值可在无需确认性检查的情况下诊断原发性醛固酮增多症（PA）。然而，由于患者数量较少且研究设计为单中心研究，这些研究受到选择偏倚的限制。

目的

本研究旨在确定 bPAC 和基础血浆肾素活性（bPRA）的截断值，以预测 PA 的确认性检查的阳性结果。

设计

本多机构、回顾性队列研究使用日本（JPAS/JRAS）的 PA 登记处进行。我们比较了在 CAP 挑战试验（CCT）或生理盐水输注试验（SIT）结果阳性的 PA 患者中 bPAC 的差异。

患者

接受 CCT（n = 2256）和/或 SIT（n = 1184）的 PA 患者。

主要观察指标

主要观察指标为 bPAC（ng/dL）和 bPRA（ng/mL/h）的截断值，以预测 CCT 和/或 SIT 阳性结果。

结果

在肾素抑制（bPRA ≤ 0.3）的患者中，预测 SIT 阳性结果的 bPAC 截断值低于预测 CCT 阳性结果的截断值（分别为 30.85 和 56.35）。在 bPRA ≤ 0.6 的患者中，bPAC 截断值≥30.85 预测 SIT 和 CCT 阳性结果的特异性仍然很高（分别为 100.0%和 97.0%）。然而，当纳入 bPRA>0.6 的患者时，bPAC 截断值≥30.85 预测 SIT 和 CCT 阳性结果的特异性降低。