欢迎来到《四川大学学报(医学版)》
李元美, 任艳, 陈涛, 等. 原发性醛固酮增多症诊断与研究进展[J]. 四川大学学报(医学版), 2020, 51(3): 267-277. DOI: 10.12182/20200560201
引用本文: 李元美, 任艳, 陈涛, 等. 原发性醛固酮增多症诊断与研究进展[J]. 四川大学学报(医学版), 2020, 51(3): 267-277. DOI: 10.12182/20200560201
LI Yuan-mei, REN Yan, CHEN Tao, et al. Update and Research Progress in the Diagnosis of Primary Aldosteronism[J]. Journal of Sichuan University (Medical Sciences), 2020, 51(3): 267-277. DOI: 10.12182/20200560201
Citation: LI Yuan-mei, REN Yan, CHEN Tao, et al. Update and Research Progress in the Diagnosis of Primary Aldosteronism[J]. Journal of Sichuan University (Medical Sciences), 2020, 51(3): 267-277. DOI: 10.12182/20200560201

原发性醛固酮增多症诊断与研究进展

Update and Research Progress in the Diagnosis of Primary Aldosteronism

  • 摘要: 原发性醛固酮增多症(primary aldosteronism,PA)是最常见的继发性高血压病因,其诊断包括筛查、确诊和分型三部分。指南推荐PA筛查首选血浆醛固酮浓度(PAC)与肾素活性(PRA)之比(ARR),确诊推荐氟氢可的松试验、生理盐水输注试验、卡托普利试验或口服高钠饮食,分型推荐肾上腺静脉采血(adrenal venous sampling, AVS),但研究发现上述每个诊断步骤均存在不足。目前国内外众多研究者正积极探索诊断效能更高且更简便的筛查指标、功能试验、影像学及病理组织学方法等。我们发现在筛查诊断中,纳入立位PAC、立位PRA和最低血钾的回归模型的优于ARR;生理盐水输注试验后血钾和钠钾比值对PA分型诊断的敏感性较低,诊断价值有限。本文将对PA诊断技术的研究及进展做详细评述。

     

    Abstract: Primary aldosteronism (PA) is the most common cause of secondary hypertension. The diagnosis procedure of PA includes screening, confirmatory diagnosis and subtype classification. International and national guidelines recommended plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio (ARR) to detect possible cases of PA, and one or more tests (fludrocortisone suppression test, saline infusion test, oral sodium loading test, or captopril challenge test) to confirm ARR positive patients. Adrenal venous sampling (AVS) is also recommended as the best method to distinguish unilateral and bilateral adrenal disease when surgical treatment is feasible and desired by the patient. However, many studies find that each of the above diagnostic method has shortcomings. Recently, more and more studies are attempting to explore new methods with higher diagnostic efficiency and more conveniences, including new screening tests, new confirmatory diagnostic tests, new imaging and pathological histology methods. In our studies, the regression model, which included upright PAC, upright PRA, and lowest potassium, is superior to ARR for PA screening; the blood potassium and the ratio of blood potassium to blood sodium after the saline infusion test are not suitable for PA subtyping. This article will review the advances and progress in PA diagnosis.

     

© 2020 《四川大学学报(医学版)》编辑部 版权所有 cc

开放获取 本文遵循知识共享署名—非商业性使用4.0国际许可协议(CC BY-NC 4.0),允许第三方对本刊发表的论文自由共享(即在任何媒介以任何形式复制、发行原文)、演绎(即修改、转换或以原文为基础进行创作),必须给出适当的署名,提供指向本文许可协议的链接,同时标明是否对原文作了修改;不得将本文用于商业目的。CC BY-NC 4.0许可协议详情请访问 https://creativecommons.org/licenses/by-nc/4.0

/

返回文章
返回