From the Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Endocrinology and Metabolism, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (West China Hospital, Chengban Branch, Sichuan University), Chengdu, China; These authors contributed equally to this article.
From the Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; These authors contributed equally to this article.
Endocr Pract. 2020 Aug;26(8):891-899. doi: 10.4158/EP-2020-0064.
We prospectively investigated the accuracy of the seated saline suppression test (SSST) in 113 patients with hypertension (including 93 primary aldosteronism [PA] and 20 essential hypertension patients) in the Department of Endocrinology and Metabolism.
Each patient underwent a recumbent saline suppression test (RSST) and SSST. The accuracy of the SSST for a confirmative PA diagnosis and subtype classification was evaluated and compared with the RSST.
The area under the receiver operating characteristic (ROC) curve of plasma aldosterone concentration (PAC) for the SSST was significantly greater than that for the RSST (0.945±0.0199 vs. 0.828 ± 0.0404; P<.05). The ROC analysis showed that the optimal PAC cut-off values were 12.94 ng/dL for the SSST (sensitivity 86.02%, specificity 95%; Youden index [YI] 0.810) and 12.04 ng/dL for the RSST (sensitivity 83.15%, specificity 57%; YI 0.401). The optimal PAC cut-off value for classifying aldosterone-producing adenoma and idiopathic hyperaldosteronism was 18.12 ng/dL for the SSST (sensitivity 73.5%, specificity 79.5%). No patients experienced adverse events during the SSST.
The SSST is safe and convenient for PA diagnosis. The accuracy of the SSST for a confirmatory diagnosis of PA was better than that of the RSST. The SSST is a reliable alternative for PA confirmation in Chinese individuals.
APA = aldosterone-producing adenoma; ARR = aldosterone to renin ratio; AVS = adrenal vein sampling; CT = computed tomography; EH = essential hypertension; IHA = idiopathic hyperaldosteronism; MRI = magnetic resonance imaging; PA = primary aldosteronism; PAC = plasma aldosterone concentration; PRA = plasma renin activity; ROC = receiver operating characteristic; RSST = recumbent saline suppression test; SSST = seated saline suppression test; YI = Youden index.
我们前瞻性地研究了 113 例高血压患者（包括 93 例原发性醛固酮增多症[PA]和 20 例特发性高血压患者）在内分泌代谢科进行坐位盐水抑制试验（SSST）的准确性。
每位患者均进行卧位盐水抑制试验（RSST）和 SSST。评估并比较了 SSST 对确诊 PA 诊断和亚型分类的准确性。
SSST 时血浆醛固酮浓度（PAC）的受试者工作特征（ROC）曲线下面积明显大于 RSST（0.945±0.0199 比 0.828 ± 0.0404；P<.05）。ROC 分析显示，SSST 的最佳 PAC 截断值为 12.94ng/dL（敏感性 86.02%，特异性 95%；Youden 指数[YI]0.810）和 RSST 的 12.04ng/dL（敏感性 83.15%，特异性 57%；YI 0.401）。SSST 对醛固酮瘤和特发性醛固酮增多症的分类的最佳 PAC 截断值为 18.12ng/dL（敏感性 73.5%，特异性 79.5%）。SSST 过程中无患者发生不良事件。
SSST 安全且方便用于 PA 诊断。SSST 对 PA 确诊的准确性优于 RSST。SSST 是中国人确诊 PA 的可靠替代方法。
APA = 醛固酮瘤；ARR = 醛固酮与肾素比值；AVS = 肾上腺静脉采样；CT = 计算机断层扫描；EH = 特发性高血压；IHA = 特发性醛固酮增多症；MRI = 磁共振成像；PA = 原发性醛固酮增多症；PAC = 血浆醛固酮浓度；PRA = 血浆肾素活性；ROC = 受试者工作特征；RSST = 卧位盐水抑制试验；SSST = 坐位盐水抑制试验；YI = Youden 指数。
