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目的探讨最适于临床筛查原发性醛固酮增多症(PA)的方案。方法收集疑诊PA的病例303例,分为PA组、原发性高血压组和无功能性肾上腺皮质意外瘤组。利用血浆醛固酮/肾素浓度比值(ARR)绘制受试者工作特征(ROC)曲线,获取最佳诊断界值。进一步对目前临床关于PA筛查的方案进行对比分析。结果立位ARR的ROC曲线下面积明显高于卧位ARR及立、卧位血浆肾素、醛固酮。立位ARR诊断PA的最佳诊断界值[(pg/ml)/(μIU/ml)]为43.45,两次立、卧位试验中至少一次立位ARR>43.45时诊断PA的灵敏度最高,达0.94;两次立位ARR均<43.45时,其除外PA的灵敏度为0.74,特异度为0.94,准确度为0.81。结论在高危人群中筛查PA,推荐行两次立位血浆肾素、醛固酮浓度测定,在两次中只要有一次立位ARR>43.45即需考虑PA可能,并进一步进行确诊试验以避免漏诊。
Objective To explore the most suitable clinical screening of primary aldosteronism (PA) program. Methods A total of 303 suspected cases of PA were collected and divided into PA group, primary hypertension group and non-functional adrenal insufficiency group. Using the plasma aldosterone / renin concentration ratio (ARR) to plot the receiver operating characteristic (ROC) curve, the best diagnostic cutoff value was obtained. Further analysis of the current clinical plan for PA screening. Results The area under the ROC curve of standing ARR was significantly higher than ARR in standing position and plasma renin and aldosterone in standing and lying position. The best diagnostic cutoff value of ARR for PA was 43.45 [(pg / ml) / (μIU / ml)]. The sensitivity of PA was highest at ARR> 43.45 0.94; the ARR of both stands <43.45, except the sensitivity of PA was 0.74, the specificity was 0.94, and the accuracy was 0.81. Conclusions Screening for PA in high-risk groups is recommended for determination of plasma renin and aldosterone concentrations in two positions, with ARR> 43.45 in one of two occasions, requiring PA to be considered and further confirmatory tests to avoid missed diagnosis.