[药物洗脱前醛固酮/直接肾素比值在原发性醛固酮增多症筛查中的应用]

[Application of aldosterone/direct renin ratio before drug washout in the screening of primary aldosteronism].

作者信息

Ma W J, Lou Y, Bian J, Cai J, Zhang H M, Zhou X L

机构信息

Hypertension Center of Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2020 Nov 10;100(41):3250-3254. doi: 10.3760/cma.j.cn112137-20200507-01459.

DOI:10.3760/cma.j.cn112137-20200507-01459

PMID:33167113

Abstract

To explore the cut-off point of aldosterone/direct renin ratio (ADRR) before drug washout in the screening for primary aldosteronism (PA) in the Chinese population and reduce the potential risk caused by drug washout during PA screening. Hospitalized hypertensive patients in the Hypertension Ward of Fuwai Hospital, Chinese Academy of Medical Sciences from January 2017 to October 2019 were enrolled. PA was diagnosed according to the criterion of 2016 American Guideline and 2016 Chinese Consensus for PA. The plasma aldosterone concentration (PAC), direct renin concentration (DRC) and ADRR before and after drug washout were measured. The receiver operating characteristic (ROC) curve of ADRR was drawn and the maximal Youden index was used to determine the best cut-off value. A total of 542 hypertensive patients were included, with 467 patients diagnosed with essential hypertension (EHT) (297 males and 170 females), and 75 patients diagnosed with PA (51 males and 24 females). Patients with PA had higher PAC and ADRR before and after drug washout than those with EHT(150.0 (130.0, 210.0) vs 120.0 (80.0, 170.0) ng/L, 170.0 (120.0, 260.0) vs 130.0 (90.0, 180.0) ng/L; 28.9 (15.9, 63.5) vs 4.3 (1.9, 11.8) (ng/L) / (mU/L) , 55.6 (39.0, 109.0) vs 9.8 (4.5, 21.3) (ng/L) /(mU/L), all 0.001). However, DRC of PA patients before and after washout were lower than those with EHT (4.0 (2.0, 10.0) vs 27.0 (10.0, 64.0) mU/L, 3.0 (2.0, 4.0) vs 12.2 (5.0, 27.0) mU/L, 0.001). In EHT and PA groups, PAC and ADRR significantly increased (0.001, 0.001) , but DRC significantly decreased after drug washout (all 0.001) . The area under the ROC curve of ADRR before drug washout was 0.868 (95 0.836-0.895) with the best cut-off value of 7.8 (ng/L) / (mU/L) for the screening of PA .The sensitivity and specificity was 94.7% and 66.8%, respectively, with the maximal Youden index of 0.615. ADRR before drug washout > 7.8 (ng/L) / (mU/L) can be used as an alternative cut-off point to screen PA when drug washout is not available.

摘要

探索中国人群原发性醛固酮增多症（PA）筛查中药物洗脱前醛固酮/直接肾素比值（ADRR）的切点，以降低PA筛查过程中药物洗脱带来的潜在风险。纳入2017年1月至2019年10月在中国医学科学院阜外医院高血压病房住院的高血压患者。根据2016年美国PA指南和2016年中国PA专家共识的标准诊断PA。测量药物洗脱前后的血浆醛固酮浓度（PAC）、直接肾素浓度（DRC）和ADRR。绘制ADRR的受试者工作特征（ROC）曲线，并使用最大约登指数确定最佳切点。共纳入542例高血压患者，其中467例诊断为原发性高血压（EHT）（男性297例，女性170例），75例诊断为PA（男性51例，女性24例）。PA患者药物洗脱前后的PAC和ADRR均高于EHT患者（150.0（130.0，210.0）对120.0（80.0，170.0）ng/L，170.0（120.0，260.0）对130.0（90.0，180.0）ng/L；28.9（15.9，63.5）对4.3（1.9，11.8）（ng/L）/（mU/L），55.6（39.0，109.0）对9.8（4.5，21.3）（ng/L）/（mU/L），均P<0.001）。然而，PA患者洗脱前后的DRC低于EHT患者（4.0（2.0，10.0）对27.0（10.0，64.0）mU/L，3.0（2.0，4.0）对12.2（5.0，27.0）mU/L，P<0.001）。在EHT和PA组中，药物洗脱后PAC和ADRR显著升高（均P<0.001），但DRC显著降低（均P<0.001）。药物洗脱前ADRR的ROC曲线下面积为0.868（95%CI 0.836 - 0.895），筛查PA的最佳切点为7.8（ng/L）/（mU/L）。敏感性和特异性分别为94.7%和66.8%，最大约登指数为0.6分。当无法进行药物洗脱时，药物洗脱前ADRR>7.8（ng/L）/（mU/L）可作为筛查PA的替代切点。