摘要
目的回顾分析并比较原发性醛固酮增多症（原醛症）、原发性高血压（EH）和嗜铬细胞瘤3种不同病因高血压患者血浆肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ）、醛固酮水平的差异及探讨运用醛固酮／PRA比值（ARR）的不同切点在高血压人群中筛查原醛症的敏感性和特异性。方法采用放射免疫法测定北京协和医院内分泌科诊断的111例特发性醛固酮增多症（IHA）、118例分泌醛固酮的-肾上腺皮质腺瘤（APA）、98例嗜铬细胞瘤及86例EH共计413例患者卧位及立位加速尿刺激后的血浆醛固酮、AngⅡ及PRA并计算ARR。结果卧位及立位的血浆醛固酮水平在原醛症组[471（346，632）pmol／L和673（499，825）pmol／L]及嗜铬细胞瘤组[374（294，465）pmol／L和629（449，997）pmo]／L]均高于EH组[277（224，332）pmol／L和427（341，501）pmol／L]，P值均〈0．01，原醛症组中的APA组[576（416，731）pmol／L和726（554，906）pmol／L]高于IHA组[399（313，504）pmol／L和609（485，776）pmol／L]，P〈0．01；卧位及立位的血浆AngⅡ水平在原醛症组[43．2（26．4，74．4）ng／L和60．1（38．5，103．6）ng／L]明显低于EH组[56．7（43．3，78．9）ng／L和84．3（61．3，108．4）ng／I~]和嗜铬细胞瘤组[54．3（29．9，101．5）ng／L和102．8（49．9，167．0）ng／L]，P值均〈0．01，而IHA组与APA组之间差异无统计学意义；卧位及立位的血浆PRA为嗜铬细胞瘤组[0．3（0．2，1．0）μg·L^-1·h^-1和1．4（0．6，3．4）μg·L^-1·h^-1]〉EH组[0．2（0．1，0．4）μg·L^-1·h^-1和0．6（0．4，1．0）μg·L^-1·h^-1]〉原醛症组[0．1（0．1，0．1）μg·L～·h^-1和0．2（0．1，0．3）μg·L～·h^-1]，P值均〈0．01，而APA组[0．1（0．1，0．1）μg·L^-1·h^-1和0．1（0．1，0．3）μg·L^-1·h^-1]〈IHA组[0．1（0．1，0．2）μg·L^-1·h^-1和0．2（0．1，0．3）μg·L^-1·h^-1]（卧位P〈0．01；立位P〈0．05）；对肾素·AngⅡ有反应APA（26例）的醛固酮水平卧位低于、而立位高于肾素-AngⅡ无反应APA（92例）；立位ARR：原醛症组〉EH组（P〈0．01）〉嗜铬细胞瘤组（P〈0．05）、APA组〉IHA组（P〈0．01）。立位ARR为40（醛固酮单位：ng／dl；PRA单位：μg·L^-1·h^-1；醛固酮单位换算为pmol／L需乘以27．7，下同）时初筛原醛症的敏感性为93％，特异性为76％。结论醛固酮、PRA和AngⅡ水平在原醛症、EH和嗜铬细胞瘤患者中明显不同；可选择立位ARR为40作为切点在高血压患者中筛查原醛症。
Objective To study on the difference of plasma renin activity （PRA）, angiotensin Ⅱ （Ang Ⅱ ）, and aidosterone levels in patients with essential hypertension （EH） or primary aldosteronism （PA） or pheochromocytoma （PHEO） , and to analyze the sensitivity and specificity on the diagnosis of PA among patients with hypertension with aldosterone/PRA ratio （ARR）. Methods The plasma aldosterone, Ang ]l and PRA concentrations in supine and upright positions were measured by radioimmunoassay from 413 patients including idiopathic hyperaldosteronism （ IHA, n = 111 ） , aldosterone-producing adenoma （APA, n = 118） , PHEO （n =98） and EH （n =86）. ARR was calculated. Results Plasma aldosterone concentrations in both of supine and uptight positions in PHEO group [ 374 （294, 465 ） pmol/L and 629 （449, 997）pmol/L] and PA group [471（346, 632） pmol/L and 673（499,825） pmol/L] were higher than those in EH group [ 277 （224, 332） pmol/L and 427 （341, 501 ） pmol/L ] （P 〈 0. 01 ）. They were also higher in APA group [576（416, 731） pmol/L and 726（554, 906）pmol/L] than those in IHA group [399（313, 504） pmol/L and 609（485, 776）pmol/L ] （P〈0. 01）. Ang II levels in both positions were lower in PA group [43.2（26.4, 74.4） ng/L and 60. 1 （38.5, 103.6） ng/L] than in EH group [56.7 （43.3, 78.9） ng/L and 84.3（61.3, 108.4） ng/L] or PHEO group [54.3（29.9, 101.5） ng/L and 102. 8 （49. 9,167. 0） ng/L ] （all P values 〈 0. 01 ）, and there was no difference between IHA and APA group （ P 〉 0. 05 ）. The PRA level in both positions of each group were PHEO group [ 0. 3 （0. 2,1.0） μg·L^-1·h^-1 and 1.4（0.6,3.4） μg·L^-1·h^-1] 〉EHgroup [0.2（0.1,0.4）μg·L^-1·h^-1 and0.6（0.4, 1.0）μg·L^-1·h^-1] （P〈0.01） 〉PA group [0.1（0. 1,0.1）μg·L^-1·h^-1 and 0.2（0.1,0.3）μg·L^-1·h^-1] （P〈0.01）, and APA group [0.1（0.1, 0.1）μg·L^-1·h^-1 and0.1（0.1, 0.3）μg·L^-1·h^-1] 〈IHAgroup [0.1（0.1, 0.2）μg·L^-1·h^-1 and0.2（0.1, 0.3）μg·L^-1·h^-1 （supine P〈 0. 01; uptight P 〈 0. 05 ）. APA was divided into 2 types with renin-Ang II-responsive APA （n = 26） and unresponsive APA （ n = 92）. The plasma aldosterone concentration was lower in supine position but higher in uptight position in renin-Ang lI-responsive APA than in unresponsive APA patients. ARR in uptight was higher in PA group （P 〈0. 01 ） but lower in PHEO group （P 〈0. 05） compared with EH. ARR was higher in APA than in IHA （P 〈 0. 01 ）. The sensitivity and specificity of ARR as 40 （ aldosterone unit： ng/dl; PRA unit：μg·L^-1·h^-1; its value should multiply 27.7 when transferred to pmol/L, simili） were 93% and 76%, respectively. Conclusion The levels of PRA, Ang Ⅱ and aldosterone from patients with EH, PA and PHEO are significant different. ARR as 40 in uptight position could be used for PA screening cutoff point.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2012年第4期294-298,共5页
Chinese Journal of Internal Medicine
基金
教育部博士点基金（20091106110013）
