论文部分内容阅读
目的血浆醛固酮/血浆肾素活性比值(ARR)测定是目前从高血压患者中检出原发性醛固酮增多症(原醛)患者最常用和有效的筛选方法。ARR 值在不同人种中有很大差别,测定条件对其结果影响较大。本研究在严格控制药物、体位等条件下,建立中国人筛选原醛 ARR 值。方法根据肾上腺增强 CT 检查结果,将110例高血压患者分为原发性高血压组(65例)和肾上腺腺瘤/增生组(45例)。停用对肾素和醛固酮分泌有影响的降压药物至少2周,利尿剂包括螺内酯停用4周。对于不宜停服降压药物的患者,改服非双氢吡啶类钙拮抗剂维拉帕米缓释片(varapamil-SR)和(或)α受体阻滞剂特拉唑嗪(terazosin)。低血钾患者补钾至正常水平。采血日晨起保持立位2 h 后,于上午9～10点立位取肘静脉血测定血浆肾素活性、血浆醛固酮浓度,计算 ARR。结果 ARR 值以醛固酮 pg/ml/肾素活性 ng·ml~(-1)·h~(-1)为单位。立位 ARR 值在原发性高血压组为100.00±48.65,肾上腺腺瘤/增生组为699.33±213.33。由 ROC 曲线所得切割值为240,立位 ARR 较卧位 ARR 更有筛查价值。在肾上腺腺瘤/增生组93.3%(42/45)患者的 ARR 值高于240,原发性高血压组90.7%(59/65)患者ARR 值低于该值。取 ARR 值240为切割点,我们从近178例高血压患者中检出15例原醛患者(手术病理证实),所有15例患者 ARR 均大于240,显示极高的敏感性和特异性。结论采用本研究试验条件,中国人立位 ARR 值为240。ARR 测定是一项简便、有效的原醛筛查方法,测定时须注意体位、药物、血钾的影响。
Purpose The plasma aldosterone / plasma renin activity ratio (ARR) assay is the most commonly used and effective screening method for patients with essential aldosteronism (primary aldosteronism) detected in hypertensive patients. The value of ARR varies greatly among different races, and the measurement conditions have a great effect on the result. In this study, under strict control of drugs, body position and other conditions, the establishment of Chinese screening of primary aldehyde ARR value. Methods According to the result of adrenal enhancement CT, 110 cases of hypertension were divided into primary hypertension group (65 cases) and adrenal adenoma / hyperplasia group (45 cases). Disable antihypertensive drugs that affect renin and aldosterone secretion for at least 2 weeks and diuretics include spironolactone for 4 weeks. For patients should not stop taking antihypertensive drugs, change non-dihydropyridine calcium antagonist verapamil sustained-release tablets (varapamil-SR) and (or) α receptor blocker terazosin. Hypokalemia potassium to normal levels. Blood collected on the morning to maintain standing position 2 h, 9 am to 10 o’clock in the morning to take elbow venous blood plasma renin activity, plasma aldosterone concentration calculated ARR. Results The ARR value was expressed in terms of aldosterone pg / ml / renin activity ng · ml ~ (-1) · h ~ (-1). The ARR of standing position was 100.00 ± 48.65 in primary hypertension group and 699.33 ± 213.33 in adrenal adenoma / hyperplasia group. The cut-off value obtained from the ROC curve was 240, and the stand-up ARR was more screened than the recumbent ARR. The ARR was higher in patients with adrenal adenoma / hyperplasia 93.3% (42/45) than in patients with ARR 90.0% (59/65). Taking an ARR of 240 as the cut-off point, we detected 15 patients with primary aldosteronism (confirmed by surgical pathology) from nearly 178 patients with hypertension. All 15 patients had an ARR of greater than 240, indicating extremely high sensitivity and specificity. Conclusion According to the experimental conditions in this study, Chinese people stand ARR 240. ARR determination is a simple and effective method of primary aldehyde screening, determination should pay attention to body position, drugs, serum potassium.