A subtype prediction score for primary aldosteronism
A subtype prediction score for primary aldosteronism
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DOI：
10.1038/jhh.2014.20
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发表时间：
2014-12-01
影响因子：
2.7
通讯作者：
Naruse, M.
中科院分区：
文献类型：
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作者：
Nanba, K.;Tsuiki, M.;Naruse, M.
原发性醛固酮增多症（PA）是内分泌高血压最常见的原因。虽然肾上腺静脉采样（AVS）被推荐为PA亚型分类的金标准程序，但它是一种可用性有限的专业技术。本研究的目的是开发一个评分系统，预测PA亚型的临床特征。研究了71例PA患者。根据AVS、手术和/或术后临床病程，受试者被诊断为单侧（n = 32）或双侧（n = 39）疾病。将单变量分析中与偏侧性相关的变量输入多变量logistic回归模型，并将回归系数用于构建亚型预测评分。然后使用受试者工作特征（ROC）曲线分析评估评分的诊断意义。亚型预测评分计算如下：血清钾= 165 pg/ml（-1），3分;在开搏通后激发试验中醛固酮与肾素比值>= 1000（血浆肾素活性单位ng/ml（-1）h（-1）），3分。ROC曲线分析显示，5分的评分具有75%的灵敏度和95%的特异性，3分的评分具有97%的灵敏度和59%的特异性。ROC曲线下面积为0.920（95%置信区间，0.859-0.979）。我们的亚型预测评分可以区分单侧和双侧PA，并有助于选择术前应接受AVS的患者。
Primary aldosteronism (PA) is the most common cause of endocrine hypertension. Although adrenal venous sampling (AVS) is recommended as the gold standard procedure for subtype classification in PA, it is a specialized technique with limited availability. The objective of this study was to develop a scoring system that predicted PA subtype using clinical characteristics. Seventy-one patients with PA were studied. The subjects were diagnosed as having either unilateral (n = 32) or bilateral disease (n = 39) based on AVS, surgery and/or the postoperative clinical course. Variables associated with laterality in the univariate analysis were entered into multivariable logistic regression models and the regression coefficients were used to construct a subtype prediction score. The diagnostic significance of the score was then evaluated using receiver operating characteristic (ROC) curve analysis. The subtype prediction score was calculated as follows: serum potassium = 165 pg ml(-1), 3 points; and aldosterone to renin ratio >= 1000 in a post-captopril challenge test (plasma renin activity in ng ml(-1) h(-1)), 3 points. ROC curve analysis for the ability to discriminate between unilateral and bilateral PA showed that a score of 5 points had 75% sensitivity and 95% specificity, and a score of 3 points had a sensitivity of 97% and a specificity of 59%. The area under the ROC curve was 0.920 (95% confidence interval, 0.859-0.979). Our subtype prediction score could discriminate between unilateral and bilateral PA and is useful for selecting patients who should undergo AVS before surgery.