卡托普利试验在醛固酮瘤无创诊断中的临床价值
[Clinical value of captopril test in noninvasive diagnosis of aldosterone-producing adenoma].
作者信息
Dong B, Ma X W, Guo X H, Gao Y, Zhang J Q
机构信息
Department of Endocrinology, Peking University First Hospital, Beijing 100034, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2021 Dec 18;53(6):1128-1132. doi: 10.19723/j.issn.1671-167X.2021.06.020.
OBJECTIVE
To analyze the clinical characteristics of aldosterone-producing adenoma (APA) subtypes in primary aldosteronism (PA) and the application value of captopril challenge test (CCT) in adenomas. And to find out the clinically specific non-invasive index for identifying APA subtypes from PA.
METHODS
The clinical data of hospitalized patients with hypertension were retrospectively collected. All the patients were conducted with the CCT and 90 patients with PA were confirmed. Among them, 34 patients were confirmed to have APA by surgery. The clinical indicators of the two groups of patients including plasma aldosterone concentration (PAC), aldosterone inhibition rate (%), and aldosterone to renin ratio (ARR) before and after the CCT were compared, the receiver operating characteristic (ROC) curves for the relevant indicators before and after the CCT drawn, and the areas under the curve (AUC) compared. The ROC curves were used to analyze the efficiency of the different CCT diagnostic criteria for diagnosing APA.
RESULTS
Compared with the PA group, the duration of hypertension was shorter, the incidence of hypokalemia was higher, and the average serum potassium level was lower when APA was diagnosed. There were no significant differences in blood pressure level, gender, serum sodium and body mass index between the two groups. Compared with PA population, APA group had higher PAC and ARR whether before or after the CCT, but lower plasma renin concentration (PRC). In APA patients, the mean degree of PAC declined after CCT was approximately 5.7%, but 5% with that of PA. As for diagnosing, ARR before or after CCT had diagnostic value for APA, in which the ARR cut-off point was 7.12, which yielded a sensitivity and specificity of 35.85% and 77.78%. The cut-off point of ARR after CCT was 4.23, with a sensitivity of 71.43% and specificity of 62.22%. For the diagnosis, the ARR before and after CCT were of no significant difference. However, the diagnostic specificity of ARR>7.12 combined with hypokalemia was up to 80%.
CONCLUSION
ARR before or after CCT have clinical value for the diagnosis of APA from PA, when combined with hypokalemia yielded high specificity.
目的
分析原发性醛固酮增多症（PA）中醛固酮瘤（APA）亚型的临床特征及卡托普利激发试验（CCT）在腺瘤中的应用价值。并找出从PA中鉴别APA亚型的临床特异性非侵入性指标。
方法
回顾性收集高血压住院患者的临床资料。所有患者均进行CCT，确诊PA患者90例。其中34例经手术确诊为APA。比较两组患者CCT前后的血浆醛固酮浓度（PAC）、醛固酮抑制率（%）和醛固酮与肾素比值（ARR）等临床指标，绘制CCT前后相关指标的受试者操作特征（ROC）曲线，并比较曲线下面积（AUC）。利用ROC曲线分析不同CCT诊断标准诊断APA的效率。
结果
与PA组相比，APA诊断时高血压病程较短，低钾血症发生率较高，平均血清钾水平较低。两组血压水平、性别、血清钠和体重指数无显著差异。与PA人群相比，APA组CCT前后的PAC和ARR均较高，但血浆肾素浓度（PRC）较低。在APA患者中，CCT后PAC平均下降幅度约为5.7%，而PA患者为5%。对于诊断，CCT前后的ARR对APA均有诊断价值，其中ARR切点为7.12，敏感性和特异性分别为35.85%和77.78%。CCT后ARR切点为4.23，敏感性为71.43%，特异性为62.22%。对于诊断，CCT前后的ARR无显著差异。然而，ARR>7.12联合低钾血症的诊断特异性高达80%。
结论
CCT前后ARR对PA中APA的诊断具有临床价值，联合低钾血症时特异性较高。
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