Chen Shi-Han, Luo Pan-Yu, Yu Ye-Rong
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2021 Jan;52(1):134-141. doi: 10.12182/20201260301.
To investigate the diagnostic value of different captopril challenge test (CCT) diagnostic criteria for diagnosing primary aldosteronism (PA).
We collected the clinical data of 184 patients with hypertension retrospectively in West China Hospital of Sichuan University. Receiver operating characteristic (ROC) curves were used to analyze the post-CCT efficacy of aldosterone renin activity ratio (ARR), plasma aldosterone concentration (PAC), plasma renin activity (PRA) and PAC suppression rate for PA diagnosis.
This study included 125 cases of primary aldehyde (PA group) and 59 cases of essential hypertension (EH group), and there were 38 normal renin primary hypertension (NREH group) and 21 low renin primary hypertension (LREH group) in EH group. The post-CCT PAC suppression rate (median (P , P )) of EH and PA group were 0.190 (0.083, 0.351) and 0.125 (0.024, 0.237), respectively. Compared with the NREH group, the basic and post-CCT PRA of LREH group were lower ( <0.001), and there were no significant differences compared with the PA group ( >0.05). We found significant overlap of post-CCT PRA and ARR between PA group and LREH group, while the overlap of post-CCT PAC between the two groups was small. In differential diagnosis of PA and EH, the areas under ROC curve of the post-CCT ARR, PAC, PRA and PAC suppression rate were 0.860 (95% confidence interval ( : 0.800-0.907), 0.881 (95% : 0.825-0.924), 0.771 (95% : 0.703-0.831) and 0.632 (95% : 0.558-0.701), respectively. There was no significant difference between the first two indexes ( =0.443, =0.658), and both of them were higher than the latter two ( <0.05). The optimal post-CCT cut-off values for ARR and PAC in differential diagnosis of PA and EH were 19.24 ng·dL with a sensitivity of 78.4% and a specificity of 88.1%, and 32.47 (ng·dL )/(ng·mL ·h ) with a sensitivity of 84.17% and a specificity of 72.41%.
Both ARR and PAC have higher diagnostic value than the post-CCT PAC suppression rate, post-CCT PAC is especially suitable as a confirmatory testing criterion of PA.
探讨不同卡托普利激发试验（CCT）诊断标准对原发性醛固酮增多症（PA）的诊断价值。
回顾性收集四川大学华西医院184例高血压患者的临床资料。采用受试者工作特征（ROC）曲线分析CCT后醛固酮肾素活性比值（ARR）、血浆醛固酮浓度（PAC）、血浆肾素活性（PRA）及PAC抑制率对PA诊断的效能。
本研究纳入原发性醛固酮增多症患者125例（PA组），原发性高血压患者59例（EH组），其中EH组中包括38例正常肾素原发性高血压（NREH组）和21例低肾素原发性高血压（LREH组）。EH组和PA组CCT后PAC抑制率（中位数（P，P））分别为0.190（0.083，0.351）和0.125（0.024，0.237）。与NREH组比较，LREH组基础及CCT后PRA均降低（<0.001），与PA组比较差异无统计学意义（>0.05）。发现PA组与LREH组CCT后PRA和ARR存在明显重叠，而两组CCT后PAC重叠较小。在PA与EH的鉴别诊断中，CCT后ARR、PAC、PRA及PAC抑制率的ROC曲线下面积分别为0.860（95%可信区间（：0.800 - 0.907）、0.881（95%：0.825 - 0.924）、0.771（95%：0.703 - 0.831）和0.632（95%：0.558 - 0.701）。前两个指标之间差异无统计学意义（=0.443，=0.658），且均高于后两个指标（<0.05）。PA与EH鉴别诊断中，CCT后ARR和PAC的最佳截断值分别为19.24 ng·dL，灵敏度为78.4%，特异度为88.1%；32.47（ng·dL）/（ng·mL·h），灵敏度为84.17%，特异度为72.41%。
ARR和PAC的诊断价值均高于CCT后PAC抑制率，CCT后PAC尤其适合作为PA的确诊试验标准。
