Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Endocrinology, Neijiang First People's Hospital, Chongqing, China.
Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Endocr Pract. 2021 Apr;27(4):326-333. doi: 10.1016/j.eprac.2020.10.016. Epub 2020 Dec 14.
The saline suppression test (SST) and captopril challenge test (CCT) are commonly used confirmatory tests for primary aldosteronism (PA). Seated SST (SSST) has been reported to be superior to recumbent SST. Whether SSST is better than CCT remains unclear. We aimed to compare the diagnostic accuracy of SSST and CCT in a prospective study.
Hypertensive patients at a high risk of PA were consecutively included. Patients with an aldosterone-renin ratio of ≥1.0 ng/dL/μIU/mL were asked to complete SSST, CCT, and the fludrocortisone suppression test (FST). Using FST as a reference standard (plasma aldosterone concentration [PAC] post FST ≥ 6.0 ng/dL), area under the receiver-operating characteristic curve (AUC), sensitivity, and specificity of SSST and CCT were calculated, and multiple regression analyses were performed to identify potential factors leading to false diagnosis.
A total of 196 patients diagnosed with PA and 73 with essential hypertension completed the study. Using PAC post SSST and PAC post CCT to confirm PA, SSST and CCT had comparable AUCs (AUC 0.87 [95% CI 0.82-0.91] vs AUC 0.88 [0.83-0.95], P = .646). When PAC post SSST and post CCT were set at 8.5 and 11 ng/dL, respectively, the sensitivity and specificity of SSST (0.72 [0.65, 0.78] and 0.86 [0.76, 0.93]) and CCT (0.73 [0.67, 0.80] and 0.85 [0.75, 0.92]) were not significantly different. In the multiple regression analyses, 1-SD increment of sodium intake resulted in a 40% lower risk of false diagnosis with SSST.
SSST and CCT have comparable diagnostic accuracy. Insufficient sodium intake decreases the diagnostic efficiency of SSST but not of CCT. Since CCT is simpler and cheaper, it is preferred over SSST.
盐水抑制试验（SST）和卡托普利激发试验（CCT）是原发性醛固酮增多症（PA）常用的确诊性试验。已报道卧位 SST（SSST）优于坐位 SST。但 SSST 是否优于 CCT 尚不清楚。我们旨在前瞻性研究中比较 SSST 和 CCT 的诊断准确性。
连续纳入高血压高危 PA 患者。当醛固酮-肾素比值≥1.0 ng/dL/μIU/mL 时，患者被要求完成 SSST、CCT 和氟氢可的松抑制试验（FST）。以 FST 作为参考标准（FST 后血浆醛固酮浓度 [PAC]≥6.0 ng/dL），计算 SSST 和 CCT 的受试者工作特征曲线下面积（AUC）、敏感度和特异度，并进行多元回归分析以确定导致假阳性诊断的潜在因素。
共 196 例 PA 患者和 73 例原发性高血压患者完成了研究。使用 SSST 后和 CCT 后 PAC 来确诊 PA，SSST 和 CCT 的 AUC 相当（AUC 0.87[95%CI 0.82-0.91] vs AUC 0.88[0.83-0.95]，P=0.646）。当 SSST 后和 CCT 后 PAC 分别设定为 8.5 和 11 ng/dL 时，SSST（0.72[0.65, 0.78]和 0.86[0.76, 0.93]）和 CCT（0.73[0.67, 0.80]和 0.85[0.75, 0.92]）的敏感度和特异度并无显著差异。多元回归分析显示，钠摄入量增加 1-SD，SSST 的假阳性诊断风险降低 40%。
SSST 和 CCT 的诊断准确性相当。钠摄入不足会降低 SSST 的诊断效率，但不会降低 CCT 的诊断效率。由于 CCT 更简单、更便宜，因此优于 SSST。
