Lo Clara Wai-Shan, Cheng Jenny Yeuk-Ki, Tsui Teresa Kam-Chi, Ma Ronald Ching-Wan, Chan Michael Ho-Ming, Ozaki Risa, Ho Chung-Shun
Department of Chemical Pathology, 26451 The Chinese University of Hong Kong, Prince of Wales Hospital , Statin, NT, Hong Kong.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Statin, NT, Hong Kong.
Clin Chem Lab Med. 2025 Apr 7;63(9):1749-1756. doi: 10.1515/cclm-2024-1312. Print 2025 Aug 26.
Primary aldosteronism (PA) is a common cause of secondary hypertension. The aldosterone-to-renin ratio (ARR) is the current recommended biomarker for PA screening, but it has limitations. This study evaluates another ratio, the aldosterone-to-angiotensin II ratio (AAIIR), as an alternative screening tool for PA.
Archived plasma samples for ARR from a group of 152 hypertensive patients undergoing PA screening were retrieved for AAIIR analyses. Both AAIIR and ARR were measured by liquid chromatography-mass spectrometry methods. Correlation analysis, sensitivity, specificity, and receiver operating characteristic (ROC) curve analysis were performed to assess the diagnostic performance of AAIIR relative to ARR.
AAIIR showed a strong positive correlation with ARR (r=0.79, p<0.0001). The area under the ROC curve for AAIIR (0.94, 95 % CI: 0.90-0.98) was satisfactory and not significantly different from ARR (0.94, 95 % CI: 0.90-0.97, p=0.877). The optimal cutoff values were 577 (pmol/L)/(µg/L) and 60 for ARR and AAIIR, respectively. The sensitivity of AAIIR was slightly higher than ARR (91 vs. 88 %), while the specificity was comparable (85 vs. 86 %).
AAIIR demonstrates a comparable diagnostic performance to ARR for PA screening, with potential advantages in efficiency and reliability. Further large-scale studies are needed to validate its efficacy and establish its role in routine clinical practice.
原发性醛固酮增多症（PA）是继发性高血压的常见病因。醛固酮与肾素比值（ARR）是目前推荐用于PA筛查的生物标志物，但它存在局限性。本研究评估另一个比值，即醛固酮与血管紧张素II比值（AAIIR），作为PA的替代筛查工具。
从一组152例接受PA筛查的高血压患者中检索存档的用于ARR分析的血浆样本，进行AAIIR分析。AAIIR和ARR均采用液相色谱-质谱法测量。进行相关性分析、敏感性、特异性和受试者工作特征（ROC）曲线分析，以评估AAIIR相对于ARR的诊断性能。
AAIIR与ARR呈强正相关（r = 0.79，p < 0.0001）。AAIIR的ROC曲线下面积（0.94，95%CI：0.90 - 0.98）令人满意，与ARR（0.94，95%CI：0.90 - 0.97，p = 0.877）无显著差异。ARR和AAIIR的最佳截断值分别为577（pmol/L）/（μg/L）和60。AAIIR的敏感性略高于ARR（91%对88%），而特异性相当（85%对86%）。
AAIIR在PA筛查中表现出与ARR相当的诊断性能，在效率和可靠性方面具有潜在优势。需要进一步的大规模研究来验证其有效性，并确定其在常规临床实践中的作用。
