Adilijiang Munire, Luo Qin, Wang Menghui, Zhang Delian, Yao Xiaoguang, Wang Guoliang, Zhou Keming, Li Nanfang
Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, China.
Int J Endocrinol. 2021 Feb 17;2021:5757305. doi: 10.1155/2021/5757305. eCollection 2021.
To clarify whether it has some hidden diagnostic values for PA, especially in the case of an inconclusive SIT result, we investigated the difference in changes of plasma renin activity (PRA) during SIT between patients with PA and non-PA.
We measured and compared the SIT parameters of 159 PA patients, 368 non-PA patients, and 43 inconclusive patients who were included in this study.
The PA group showed a minor change of PRA during the SIT (ΔPRA, defined as (pre-SIT PRA-post-SIT PRA)) compared with the non-PA group (0.17 ng/ml/h vs. 1.07 ng/ml/h, < 0.001). According to ROC analysis, ΔPRA showed a greater AUC than post-SIT PRA (0.897 vs. 0.855, < 0.001). The cutoff value was 0.5 ng/ml/h, with 90.3% sensitivity and 78.6% specificity. When combined with ARR post-SIT, it showed 81.6% sensitivity and 97.0% specificity for PA diagnosis. Further analysis of 43 patients with an inconclusive SIT result who completed AVS found that ΔPRA was smaller in the confirmed PA group compared with the unconfirmed PA group (0.19 ng/ml/h vs. 0.29 ng/ml/h, < 0.05); there was no significant difference in PAC post-SIT between two groups. ΔPRA ≤ 0.21 ng/ml/h provides 71.4% sensitivity, 80.0% specificity, and 87.0% PPV for their PA diagnosis.
PA patients show minor PRA change during SIT; the change of PRA during SIT provides an auxiliary diagnostic value for PA, especially in patients with an inconclusive SIT result.
为阐明其对原发性醛固酮增多症（PA）是否具有一些潜在的诊断价值，尤其是在生理盐水输注试验（SIT）结果不明确的情况下，我们研究了PA患者与非PA患者在SIT期间血浆肾素活性（PRA）变化的差异。
我们测量并比较了纳入本研究的159例PA患者、368例非PA患者和43例结果不明确患者的SIT参数。
与非PA组相比，PA组在SIT期间PRA变化较小（ΔPRA，定义为（SIT前PRA - SIT后PRA））（0.17 ng/ml/h对1.07 ng/ml/h，P < 0.001）。根据ROC分析，ΔPRA的曲线下面积（AUC）大于SIT后PRA（0.897对0.855，P < 0.001）。截断值为0.5 ng/ml/h，敏感性为90.3%，特异性为78.6%。当与SIT后醛固酮肾素比值（ARR）联合使用时，对PA诊断的敏感性为81.6%，特异性为97.0%。对43例完成肾上腺静脉采样（AVS）且SIT结果不明确的患者进行进一步分析发现，确诊PA组的ΔPRA低于未确诊PA组（0.19 ng/ml/h对0.29 ng/ml/h，P < 0.05）；两组SIT后醛固酮浓度（PAC）无显著差异。ΔPRA≤0.21 ng/ml/h对PA诊断的敏感性为71.4%，特异性为80.0%，阳性预测值为87.0%。
PA患者在SIT期间PRA变化较小；SIT期间PRA的变化为PA提供了辅助诊断价值，尤其是在SIT结果不明确的患者中。
