Department of Clinical Laboratory, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China.
Department of Clinical Laboratory, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, China.
Chin Med J (Engl). 2022 Mar 20;135(6):639-647. doi: 10.1097/CM9.0000000000001906.
Since the diagnostic value of aldosterone to renin ratio (ARR) calculated by plasma renin concentration (PRC) or plasma renin activity (PRA) is still inconclusive, we conducted a meta-analysis by systematically reviewing relevant literature to explore the difference in the diagnostic efficacy of ARR calculated by PRC or PRA, so as to provide guidance for clinical diagnosis.
We searched PubMed, Embase, and Cochrane Library from the establishment of the database to March 2021. We included studies that report the true positive, false positive, true negative, and false negative values for the diagnosis of primary aldosteronism, and we excluded duplicate publications, research without full text, incomplete information, or inability to conduct data extraction, animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data.
The pooled results showed that ARR (plasma aldosterone concentration [PAC]/PRC) had a sensitivity of 0.82 (95% confidence interval [CI]: 0.78-0.86), a specificity of 0.94 (95% CI: 0.92-0.95), a positive-likelihood ratio (LR) of 12.77 (95% CI: 7.04-23.73), a negative LR of 0.11 (95% CI: 0.07-0.17), and symmetric area under the curve (SAUC) of 0.982, respectively. Furthermore, the diagnostic odds ratio (DOR) of ARR (PAC/PRC) was 180.21. Additionally, the pooled results showed that ARR (PAC/PRA) had a sensitivity of 0.91 (95% CI: 0.86-0.95), a specificity of 0.91 (95% CI: 0.90-0.93), a positive LR of 7.30 (95% CI: 2.99-17.99), a negative LR of 0.10 (95% CI: 0.04-0.26), and SAUC of 0.976, respectively. The DOR of ARR (PAC/PRA) was 155.52. Additionally, we conducted a subgroup analysis for the different thresholds (<35 or ≥35) of PAC/PRC. The results showed that the DOR of the cut-off ≥35 groups was higher than the cut-off <35 groups (DOR = 340.15, 95% CI: 38.32-3019.66; DOR = 116.40, 95% CI = 23.28-581.92).
The research results suggest that the determination of ARR (PAC/PRC) and ARR (PAC/PRA) was all effective screening tools for PA. The diagnostic accuracy and diagnostic value of ARR (PAC/PRC) are higher than ARR (PAC/PRA). In addition, within a certain range, the higher the threshold, the better the diagnostic value.
由于用血浆肾素浓度（PRC）或血浆肾素活性（PRA）计算的醛固酮与肾素比值（ARR）的诊断价值仍不确定，我们通过系统综述相关文献进行了荟萃分析，以探讨用 PRC 或 PRA 计算的 ARR 的诊断效能差异，为临床诊断提供指导。
我们检索了从数据库建立到 2021 年 3 月的 PubMed、Embase 和 Cochrane Library。我们纳入了报告原发性醛固酮增多症诊断的真阳性、假阳性、真阴性和假阴性值的研究，并排除了重复发表、无全文、信息不完整或无法进行数据提取、动物实验、综述和系统评价的研究。使用 STATA 15.1 进行数据分析。
汇总结果显示，ARR（血浆醛固酮浓度[PAC]/PRC）的敏感性为 0.82（95%置信区间[CI]：0.78-0.86），特异性为 0.94（95% CI：0.92-0.95），阳性似然比（LR）为 12.77（95% CI：7.04-23.73），阴性 LR 为 0.11（95% CI：0.07-0.17），曲线下面积（AUC）的对称度为 0.982。ARR（PAC/PRC）的诊断优势比（DOR）为 180.21。此外，汇总结果显示，ARR（PAC/PRA）的敏感性为 0.91（95% CI：0.86-0.95），特异性为 0.91（95% CI：0.90-0.93），阳性 LR 为 7.30（95% CI：2.99-17.99），阴性 LR 为 0.10（95% CI：0.04-0.26），AUC 为 0.976。ARR（PAC/PRA）的 DOR 为 155.52。此外，我们对不同 PAC/PRC 截断值（<35 或≥35）进行了亚组分析。结果显示，截断值≥35 组的 DOR 高于截断值<35 组（DOR = 340.15，95% CI：38.32-3019.66；DOR = 116.40，95% CI：23.28-581.92）。
研究结果表明，ARR（PAC/PRC）和 ARR（PAC/PRA）的测定均是 PA 的有效筛查工具。ARR（PAC/PRC）的诊断准确性和诊断价值均高于 ARR（PAC/PRA）。此外，在一定范围内，截断值越高，诊断价值越好。
