Sun Kaiwen, Gong Minghui, Yu Yang, Yang Minghui, Jiang Yinong, Zhang Ying, Song Wei
Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
J Clin Hypertens (Greenwich). 2025 Sep;27(9):e70130. doi: 10.1111/jch.70130.
This study aimed to evaluate the diagnostic accuracy of 24-hour urinary aldosterone (UALD) for primary aldosteronism (PA) in Northeast China. A total of 423 patients with hypertension were consecutively enrolled. After 1:2 propensity score matching (PSM), 100 patients were classified into the PA group, and 194 patients were classified into the essential hypertension (EH) group. The clinical characteristics and biochemistry measurements were collected and analyzed. A receiver operating characteristic (ROC) curve was generated, and the area under the curve (AUC) was calculated to determine optimal diagnostic thresholds. No significant difference in age was observed between the groups (PA: 53.4 ± 11.3 years vs. EH: 52.8 ± 11.3 years, p > 0.05). The median 24-hour UALD was significantly greater in the PA group (6.4 [3.7, 13.9] µg/24 h vs. 4.8 [2.5, 7.8] µg/24 h, p < 0.05), with levels declining with age in both cohorts. The optimal UALD cutoff value was 11.4 µg/24 h (AUC = 0.652; Youden index = 0.257). For patients over 55 years, the 24-hour urinary aldosterone-to-creatinine ratio (UACR) showed superior diagnostic performance, with an optimal cutoff of 0.8 µg/mmol/L (AUC = 0.695). 24-Hour UALD was a promising diagnostic marker for PA in North China, whereas 24-hour UACR might increase accuracy in older populations. However, further studies are needed to validate these findings.
本研究旨在评估24小时尿醛固酮（UALD）对中国东北地区原发性醛固酮增多症（PA）的诊断准确性。共连续纳入423例高血压患者。经过1:2倾向评分匹配（PSM）后，100例患者被分为PA组，194例患者被分为原发性高血压（EH）组。收集并分析临床特征和生化指标。绘制受试者工作特征（ROC）曲线，并计算曲线下面积（AUC）以确定最佳诊断阈值。两组之间年龄无显著差异（PA组：53.4±11.3岁 vs. EH组：52.8±11.3岁，p>0.05）。PA组24小时UALD中位数显著更高（6.4[3.7,13.9]μg/24小时 vs. 4.8[2.5,7.8]μg/24小时，p<0.05），两个队列中的水平均随年龄下降。UALD的最佳截断值为11.4μg/24小时（AUC = 0.652；约登指数 = 0.257）。对于55岁以上的患者，24小时尿醛固酮与肌酐比值（UACR）显示出更好的诊断性能，最佳截断值为0.8μg/mmol/L（AUC = 0.695）。24小时UALD是中国北方PA的一个有前景的诊断标志物，而24小时UACR可能提高老年人群的诊断准确性。然而，需要进一步研究来验证这些发现。
