摘要
目的 回顾分析近2年在复旦大学附属中山医院内分泌科就诊的原发性醛固酮增多症(原醛)患者临床资料,评估基于血浆醛固酮质谱法、肾素放免法检测醛固酮/肾素比值(aldosterone to renin ratio,ARR)及生理盐水试验在原醛诊断中的价值及最佳诊断切点.方法 招募124名健康志愿者,确定血浆醛固酮质谱法检测的正常参考范围.纳入2016年3月至2017年11月,于我科就诊的疑诊原醛患者375例.其中241例患者进一步行生理盐水抑制试验.构建随机ARR及生理盐水抑制试验诊断原醛的受试者工作特征(ROC)曲线.结果 健康志愿者平均血浆醛固酮(9.16±6.73)ng/dl质谱法.375例疑诊原醛患者中,确诊原醛143例,原发性高血压患者232例.随机ARR ROC曲线下面积(AUC ROC)为0.837(0.787~0.886),随机ARR切点为13.84(ng/dl)/(ng/ml·h)作为筛查阳性切点,特异性78.3%,敏感性79%.生理盐水抑制试验后血浆醛固酮AUC ROC为0.807(0.747~0.867),生理盐水抑制试验后血浆醛固酮4.29 ng/dl作为原醛诊断切点,特异性90.6%,敏感性为69.6%.结论 血浆醛固酮(随机)质谱法检测的正常参考范围为2.34~22.18 ng/dl.推荐基于血浆醛固酮质谱法检测ARR>13.84(ng/dl)/(ng/ml·h)原醛筛查试验阳性,生理盐水抑制后血浆醛固酮水平>4.29 ng/dl,可以确诊原醛.
Objective Retrospective analysis of clinical data of patients with primary aldosteronism in the past 2 years,to assess the value of liquid chromatography-mass spectrometric method(LC-MS/MS)aldosterone to renin ratio(ARR)and saline infusion test and its optimal cutoff in the diagnosis of primary aldosteronism(PA).Methods A total of 124 healthy volunteers were recruited to determine the normal reference range for LC-MS/MS aldosterone.375 patients with high risk of primary aldosteronism were enrolled during March 2016 to November 2017.Among them,241 patients underwent the saline infusion test.Receiver operating characteristic(ROC)analysis was performed to compare the diagnostic accuracie and the cutoff value of random ARR and post saline infusion test.Results The average level of LC-MS/MS aldosterone in healthy volunteers was(9.16±6.73)ng/dl(95%CI 2.34-22.18 ng/dl).Among 375 patients with high risk of PA,143 patients with PA and 232 patients with essential hypertension(EH)were diagnosed.The area under the ROC curve(AUC ROC)of random ARR was 0.837(0.787-0.886),the cutoff point was 13.84(ng/dl)/(ng/ml·h),with a sensitivity of 78.3%and a specificity of 79%.Using post-test plasma aldosterone concentration(PAC)for diagnosis,AUC ROC of the saline infusion test was 0.807(0.747-0.867),the cutoff point was 4.29 ng/dl,with a sensitivity of 90.6%and a specificity of 69.6%.Conclusion The normal range of LC-MS/MS aldosterone is 2.34-22.18 ng/dl.In our research,random ARR value above 13.84(ng/dl)/(ng/ml·h)can be the cutoff point in screening the suspected PA patients.PAC post-saline infusion test more than 4.29 ng/dl is recommended to confirm PA.
作者
赵琳
蒋晶晶
陈颖
李晓牧
陆志强
郭玮
李小英
高鑫
Zhao Lin;Jiang Jingjing;Chen Ying;Li Xiaomu;Lu Zhiqiang;Guo Wei;Li Xiaoying;Gao Xin(Department of Endocrine and Metabolism,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Clincal Laboratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2019年第11期927-933,共7页
Chinese Journal of Endocrinology and Metabolism
关键词
原发性醛固酮增多症
醛固酮
质谱法检测
醛固酮/肾素比值
生理盐水试验
Primary aldosteronism
Aldosterone
Liquid chromatography-mass spectrometric method
Aldosterone to renin ratio
Saline infusion test
