Gao Hongjiao, Luo Rong, Li Jindie, Tian Haoming
Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China.
Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China.
Ann Transl Med. 2022 Jun;10(12):679. doi: 10.21037/atm-22-2272.
Primary aldosteronism (PA) refers to a spontaneous increase in adrenal aldosterone secretion, and is considered the main cause of secondary hypertension. The main aldosterone screening methods include plasma aldosterone-to-renin ratio (ARR) and plasma aldosterone/direct renin concentration ratio (ADRR). The ARR method has many limitations such as complex operation, several influencing factors, and difficulty in standardization. Relatively speaking, ADRR has gradually attracted attention due to its simple operation, stable results, and easy standardization. However, different research results have suggested that the diagnostic efficacy of ADRR in the screening of primary aldosteronism varies greatly. Meta-analysis may be a way to provide evidence-based medicine. Therefore, it is necessary to conduct a meta-analysis of the diagnostic efficacy of ADRR in primary aldosteronism to clarify the role of ADRR in the screening of PA.
The words "primary aldosteronism", "primary hyperaldosteronism", "aldosterone", "renin concentration", "hypertension" and "screening test" were used as search terms. Literature searches were conducted in the databases of PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu. According to the PICOS principles studies exploring the effectiveness of ADRR in screening for PA were included in the analysis. The research data were independently extracted and analyzed by 2 researchers. Quality assessment of diagnostic accuracy studies (QUADAS-2) was used to analyze the risk bias of the included studies.
The results showed that 10 studies met the inclusion criteria, with a total of 2,806 subjects. The meta-analysis found that the overall sensitivity and specificity were 0.87 [95% confidence interval (CI): 0.85-0.89], 0.85 (95% CI: 0.83-0.86), respectively. The area under the curve (AUC) of the summary receiver operating characteristic (SROC) curve was 0.9333. The pooled positive likelihood ratio (PLR), pooled negative likelihood ratio (NLR), and pooled diagnostic odds ratio (DOR) were 5.84 (3.67-9.30), 0.16 (0.12-0.22), and 39.82 (22.84-69.44), respectively.
This study confirmed that ADRR screening for PA has good sensitivity and specificity. Therefore, ADRR can be used to screen for PA. But the risk and problematic control should be considered.
原发性醛固酮增多症（PA）是指肾上腺醛固酮分泌自发增加，被认为是继发性高血压的主要原因。主要的醛固酮筛查方法包括血浆醛固酮与肾素比值（ARR）和血浆醛固酮/直接肾素浓度比值（ADRR）。ARR方法存在诸多局限性，如操作复杂、影响因素多且标准化困难。相对而言，ADRR因其操作简单、结果稳定且易于标准化而逐渐受到关注。然而，不同的研究结果表明ADRR在原发性醛固酮增多症筛查中的诊断效能差异很大。荟萃分析可能是提供循证医学的一种方式。因此，有必要对ADRR在原发性醛固酮增多症诊断效能方面进行荟萃分析，以阐明ADRR在PA筛查中的作用。
使用“原发性醛固酮增多症”“原发性醛固酮增多症”“醛固酮”“肾素浓度”“高血压”和“筛查试验”等词作为检索词。在PubMed、Embase、Cochrane图书馆以及中国知网（CNKI）、万方和维普等数据库中进行文献检索。根据PICOS原则，纳入探索ADRR在PA筛查有效性的研究进行分析。研究数据由2名研究人员独立提取和分析。采用诊断准确性研究的质量评估（QUADAS - 2）来分析纳入研究的风险偏倚。
结果显示，10项研究符合纳入标准，共2806名受试者。荟萃分析发现，总体敏感性和特异性分别为0.87[95%置信区间（CI）：0.85 - 0.89]、0.85（95%CI：0.83 - 0.86）。汇总受试者工作特征（SROC）曲线的曲线下面积（AUC）为0.9333。合并阳性似然比（PLR）、合并阴性似然比（NLR）和合并诊断比值比（DOR）分别为5.84（3.67 - 9.30）、0.16（0.12 - 0.22）和39.82（22.84 - 69.44）。
本研究证实ADRR筛查PA具有良好的敏感性和特异性。因此，ADRR可用于PA的筛查。但应考虑风险和问题控制。
