Hiramatsu K, Yamada T, Yukimura Y, Komiya I, Ichikawa K, Ishihara M, Nagata H, Izumiyama T
Arch Intern Med. 1981 Nov;141(12):1589-93.
In an attempt to devise a screening test for aldosterone-producing adenoma (APA) among hypertensive patients, the serum sodium and potassium levels, plasma renin activity (PRA), plasma aldosterone concentration, and aldosterone-PRA ratio were measured in 348 patients with hypertension. Nine patients with a substantially elevated aldosterone-PRA ratio were selected and hospitalized for further investigations. All nine patients were then recognized by scintigraphy with labeled cholesterol, venography, and surgical excision as having APA. The serum concentration of potassium was subnormal in three of nine patients with APA. In patients with APA, administration of diuretics and salt restriction significantly elevated PRA. However, even under notable diurnal and day-to-day variations of plasma aldosterone concentrations, the aldosterone-PRA ratio was always elevated inappropriately (more than 400) in patients with APA. In contrast, after administration of diuretics, both the PRA and aldosterone levels increased significantly in patients with essential hypertension, but the aldosterone-PRA ratio was less than 200. Since the renin-angiotensin system seems to be a major factor controlling aldosterone secretion in normal subjects, it is suggested that an elevation of aldosterone-PRA ratio more than 400 is a useful screening tool for the prediction of APA among hypertensive patients.
为了设计一种针对高血压患者的原发性醛固酮增多症腺瘤（APA）筛查试验，对348例高血压患者进行了血清钠和钾水平、血浆肾素活性（PRA）、血浆醛固酮浓度以及醛固酮 - PRA比值的测定。选取了9例醛固酮 - PRA比值显著升高的患者并住院进行进一步检查。随后通过放射性标记胆固醇闪烁扫描、静脉造影和手术切除，确认这9例患者均患有APA。9例APA患者中有3例血清钾浓度低于正常水平。在APA患者中，使用利尿剂和限制盐摄入会使PRA显著升高。然而，即使血浆醛固酮浓度存在明显的昼夜和每日波动，APA患者的醛固酮 - PRA比值始终异常升高（超过400）。相比之下，在原发性高血压患者中使用利尿剂后，PRA和醛固酮水平均显著升高，但醛固酮 - PRA比值小于200。由于肾素-血管紧张素系统似乎是正常受试者中控制醛固酮分泌的主要因素，因此建议醛固酮 - PRA比值超过400是预测高血压患者中APA的一种有用筛查工具。
