Grim C E, Luft F C, Weinberger M H, Grim C M
Ann Intern Med. 1979 Oct;91(4):617-22. doi: 10.7326/0003-4819-91-4-617.
To facilitate the identification of patients with renal vascular hypertension, we evaluated four potential screening tests: rapid-sequence urography, systolic-diastolic abdominal bruit, upright plasma renin activity (PRA), and response to saralasin infusion. Our study included 379 normal subjects, 199 essential hypertensive patients with normal renal angiograms, and 64 patients with surgically responsive renal vascular hypertension. Thirty-nine percent of patients with renal vascular hypertension had systolic-diastolic bruits, 76% abnormal urograms, and 27% a PRA greater than 30 ng of angiotensin 1/mL.3 h. Only one half of the 23 patients with renal vascular hypertension tested had a depressor response to saralasin, as did two of 13 essential hypertensive patients. In essential hypertensive subjects, 1% had systolic-diastolic bruits, 2% abnormal urograms, and 5% upright renin values greater than 30 ng of angiotensin 1/mL.3 h. The screening combination of urogram, bruit, or upright renin value offered a test sensitivity of 93%, with a specificity of 92%. The results of saralasin infusion failed to increase the diagnostic yield.
为便于识别肾血管性高血压患者，我们评估了四项潜在的筛查试验：快速序列尿路造影、收缩期 - 舒张期腹部杂音、立位血浆肾素活性（PRA）以及对沙拉新输注的反应。我们的研究纳入了379名正常受试者、199名肾血管造影正常的原发性高血压患者以及64名手术治疗有效的肾血管性高血压患者。肾血管性高血压患者中，39%有收缩期 - 舒张期杂音，76%尿路造影异常，27%的PRA大于30 ng血管紧张素I/mL·3小时。接受测试的23例肾血管性高血压患者中，只有一半对沙拉新有降压反应，13例原发性高血压患者中有2例也有此反应。在原发性高血压受试者中，1%有收缩期 - 舒张期杂音，2%尿路造影异常，5%立位肾素值大于30 ng血管紧张素I/mL·3小时。尿路造影、杂音或立位肾素值的联合筛查试验敏感性为93%，特异性为92%。沙拉新输注的结果未能提高诊断率。
