Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Medicine, Monash University, Clayton, Victoria, Australia.
Endocrine. 2024 Sep;85(3):1417-1424. doi: 10.1007/s12020-024-03885-2. Epub 2024 Jul 15.
Captopril challenge test (CCT), seated saline infusion test (SSIT), oral sodium loading test (OSLT) and fludrocortisone suppression test (FST) are widely used diagnostic tests for primary aldosteronism (PA). These tests differ in terms of safety and complexity. Whether the simpler tests (CCT and SSIT) are comparable in diagnostic performance to the more complex ones (FST and OSLT) is unclear.
To compare the diagnostic accuracy of the four tests.
This is a retrospective study of hypertensive patients who were screened for PA and completed at least one confirmatory test. The patients were divided into two cohorts: one including those who completed one to three tests was used for the estimation of sensitivity and specificity. The other including those who completed four tests was used for the comparison of accuracy. Bayesian method was used to obtain the sensitivity, specificity, and Youden index of each test.
The study included 1011 hypertensive patients. Among them, 895 patients completed one to three tests (including 889 CCT, 605 FST, 611 SSIT and 69 OSLT), and 116 patients completed four tests. SSIT had the highest sensitivity of 0.82(95% CI 0.78-0.86) but the lowest specificity of 0.76(0.70-0.80). OSLT had the lowest sensitivity of 0.65(0.56-0.75) but the highest specificity of 0.91(0.82-0.96). The sensitivity and specificity were 0.78 (95% CI, 0.75-0.82), 0.82 (95% CI, 0.78-0.85), for CCT, and 0.77 (95% CI, 0.73-0.81), 0.87 (95% CI, 0.82-0.91) for FST, respectively. The Youden index was not significantly different among the four tests[0.60(0.55-0.65) for CCT; 0.58(0.51-0.64) for SSIT; (0.64(0.57-0.69) for FST; 0.56(0.43-0.67) for OSLT].
The accuracy of simpler tests is comparable to the more complex ones. Considering the safety and simplicity of CCT, it may be a reasonable first choice when confirming the diagnosis of PA.
卡托普利激发试验（CCT）、坐位生理盐水输注试验（SSIT）、口服钠负荷试验（OSLT）和氟氢可的松抑制试验（FST）是原发性醛固酮增多症（PA）的常用诊断试验。这些试验在安全性和复杂性方面存在差异。较简单的试验（CCT 和 SSIT）与更复杂的试验（FST 和 OSLT）在诊断性能上是否相当尚不清楚。
比较这四种试验的诊断准确性。
这是一项回顾性研究，纳入了接受 PA 筛查并至少完成一项确认性试验的高血压患者。患者被分为两组：一组包括完成一至三项试验的患者，用于估计敏感性和特异性；另一组包括完成四项试验的患者，用于比较准确性。采用贝叶斯方法获得每种试验的敏感性、特异性和约登指数。
该研究纳入了 1011 名高血压患者。其中，895 名患者完成了一至三项试验（包括 889 例 CCT、605 例 FST、611 例 SSIT 和 69 例 OSLT），116 名患者完成了四项试验。SSIT 的敏感性最高，为 0.82（95%CI 0.78-0.86），但特异性最低，为 0.76（0.70-0.80）。OSLT 的敏感性最低，为 0.65（0.56-0.75），但特异性最高，为 0.91（0.82-0.96）。CCT 的敏感性和特异性分别为 0.78（95%CI，0.75-0.82）、0.82（95%CI，0.78-0.85），FST 分别为 0.77（95%CI，0.73-0.81）、0.87（95%CI，0.82-0.91）。四种试验的约登指数无显著差异[CCT 为 0.60（0.55-0.65）；SSIT 为 0.58（0.51-0.64）；FST 为 0.64（0.57-0.69）；OSLT 为 0.56（0.43-0.67）]。
较简单试验的准确性与更复杂试验相当。考虑到 CCT 的安全性和简便性，它可能是确认 PA 诊断的合理首选。
