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陈士涵, 罗盼雨, 余叶蓉. 卡托普利试验对原发性醛固酮增多症诊断价值的初步探讨[J]. 四川大学学报(医学版), 2021, 52(1): 134-141. DOI: 10.12182/20201260301
引用本文: 陈士涵, 罗盼雨, 余叶蓉. 卡托普利试验对原发性醛固酮增多症诊断价值的初步探讨[J]. 四川大学学报(医学版), 2021, 52(1): 134-141. DOI: 10.12182/20201260301
CHEN Shi-han, LUO Pan-yu, YU Ye-rong. The Diagnostic Value of Captopril Challenge Test for Primary Aldosteronism[J]. Journal of Sichuan University (Medical Sciences), 2021, 52(1): 134-141. DOI: 10.12182/20201260301
Citation: CHEN Shi-han, LUO Pan-yu, YU Ye-rong. The Diagnostic Value of Captopril Challenge Test for Primary Aldosteronism[J]. Journal of Sichuan University (Medical Sciences), 2021, 52(1): 134-141. DOI: 10.12182/20201260301

卡托普利试验对原发性醛固酮增多症诊断价值的初步探讨

The Diagnostic Value of Captopril Challenge Test for Primary Aldosteronism

  • 摘要:
      目的  评价卡托普利试验(CCT)后各试验指标对原发性醛固酮增多症(简称原醛症)的诊断价值。
      方法  回顾性收集2012年6月−2017年10月在四川大学华西医院住院的184例高血压患者的临床资料,使用受试者工作特征(ROC)曲线对CCT后血醛固酮水平/肾素活性(ARR)、血浆醛固酮水平(PAC)、血浆肾素活性(PRA)以及PAC抑制率这4项指标进行评价。
      结果  184例高血压患者中原醛症(PA组)125 例,原发性高血压(EH组)59 例,后者又分为正常肾素原发性高血压(NREH组)38 例,低肾素原发性高血压(LREH组)21 例。EH组与PA组CCT后PAC抑制率中位数(P25,P75)分别为0.190(0.083,0.351)与0.125(0.024,0.237)。LREH组CCT前、后PRA低于NREH组(P<0.001),与PA组比较则差异无统计学意义(P>0.05)。LREH组口服卡托普利后PRA和ARR与PA组有很大重叠,而服药后PAC与PA组重叠范围很小。在原醛症与原发性高血压的鉴别诊断中,CCT后ARR、PAC、PAC抑制率和PRA曲线下面积分别为0.860〔95%置信区间(CI):0.800~ 0.907〕、0.881(95%CI:0.825~0.924)、0.771(95%CI:0.703~0.831)和0.632(95%CI:0.558 ~ 0.701),前两者比较差异无统计学意义(Z=0.443,P=0.658),且均高于后两者(P<0.05)。CCT后PAC与ARR在PA组与EH组中诊断原醛症最佳切点值分别为19.24 ng·dL-1 (敏感性78.4%,特异性88.1%)和32.47 (ng·dL-1)/(ng·mL-1·h-1)(敏感性84.17%,特异性72.41%)。
      结论  CCT后ARR和PAC对原醛症诊断价值均较PAC抑制率高,尤以PAC更适合作为原醛症的确诊试验指标。

     

    Abstract:
      Objective  To investigate the diagnostic value of different captopril challenge test (CCT) diagnostic criteria for diagnosing primary aldosteronism (PA).
      Methods  We collected the clinical data of 184 patients with hypertension retrospectively in West China Hospital of Sichuan University. Receiver operating characteristic (ROC) curves were used to analyze the post-CCT efficacy of aldosterone renin activity ratio (ARR), plasma aldosterone concentration (PAC), plasma renin activity (PRA) and PAC suppression rate for PA diagnosis.
      Results  This study included 125 cases of primary aldehyde (PA group) and 59 cases of essential hypertension (EH group), and there were 38 normal renin primary hypertension (NREH group) and 21 low renin primary hypertension (LREH group) in EH group. The post-CCT PAC suppression rate (median (P25, P75)) of EH and PA group were 0.190 (0.083, 0.351) and 0.125 (0.024, 0.237), respectively. Compared with the NREH group, the basic and post-CCT PRA of LREH group were lower (P<0.001), and there were no significant differences compared with the PA group (P>0.05). We found significant overlap of post-CCT PRA and ARR between PA group and LREH group, while the overlap of post-CCT PAC between the two groups was small. In differential diagnosis of PA and EH, the areas under ROC curve of the post-CCT ARR, PAC, PRA and PAC suppression rate were 0.860 (95% confidence interval (CI): 0.800-0.907), 0.881 (95%CI: 0.825-0.924), 0.771 (95%CI: 0.703-0.831) and 0.632 (95%CI: 0.558-0.701), respectively. There was no significant difference between the first two indexes (Z=0.443, P=0.658), and both of them were higher than the latter two (P<0.05). The optimal post-CCT cut-off values for ARR and PAC in differential diagnosis of PA and EH were 19.24 ng·dL−1 with a sensitivity of 78.4% and a specificity of 88.1%, and 32.47 (ng·dL−1)/(ng·mL−1·h−1) with a sensitivity of 84.17% and a specificity of 72.41%.
      Conclusion  Both ARR and PAC have higher diagnostic value than the post-CCT PAC suppression rate, post-CCT PAC is especially suitable as a confirmatory testing criterion of PA.

     

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