Is the cut off point proper in screening of primary aldosteronism by urinary Na/K ratio. Japanese are still high in Na/K ratio
Is the cut off point proper in screening of primary aldosteronism by urinary Na/K ratio. Japanese are still high in Na/K ratio
复制标题
通过尿Na/K比值筛查原发性醛固酮增多症的临界点是否合适？
DOI：
10.1038/s41440-021-00787-y
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发表时间：
2022
影响因子：
5.4
通讯作者：
T. Shimosawa
中科院分区：
文献类型：
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作者：
T. Shimosawa
尊敬的编辑，Segawa H等人声称尿钠/钾比值可用于筛查醛固酮增多症;这一发现发表在您的期刊上（Hypertension Research第44卷，第1129 -1137页（2021））。根据表3，Na/K< 1.0的醛固酮增多症的灵敏度为~ 45%，特异性为~ 98%。当临界点增加到3.0时，敏感性为~ 91%，特异性为~ 40%。因此，Na/K< 1.0和< 3.0的阳性和阴性似然分别为22.5和0.56（< 1.0）以及6.9和0.225（< 3.0）。高醛固酮血症的患病率约为高血压的20%，这表明大多数患者具有正常或低醛固酮血症，并且Na/K比值高于临界点。以Na/K< 1.0为标准筛选高醛固酮血症时，Na/K> 1.0者占80%（阴性），高醛固酮血症的可能性降低0.56倍。相反，当我们将临界点设为Na/K< 3.0时，醛固酮增多症的可能性降低了0.225倍。一般来说，在筛查这种疾病时，我们应该选择阴性可能性较低的检测，以免漏诊。在东亚人中进行的INTERSALT研究中，Na/K比约为4.6 [1]，或在NIPPON DATA 80中更低（2.0）
Dear Editor, Segawa H et al. claim that the urinary sodium/potassium ratio can be used to screen for hyperaldosteronism; this finding appeared in your journal (Hypertension Research volume 44, pages1129–1137 (2021)). According to Table 3, the sensitivity for hyperaldosteronism by Na/K< 1.0 was~ 45%, and the specificity was~ 98%. When the cutoff point was increased to 3.0, the sensitivity was~ 91%, and the specificity was~ 40%. Therefore, the positive and negative likelihood for Na/K< 1.0 and< 3.0 are 22.5 and 0.56 for< 1.0 and 6.9 and 0.225 for< 3.0. The prevalence of hyperaldosteronism is~ 20% of hypertension, which suggests that most of the patients have normo-or low aldosteronism and that the Na/K ratio is above the cutoff point. When we screened hyperaldosteronism by Na/K< 1.0, 80% of the cases were Na/K> 1.0 (negative result), and the possibility of hyperaldosteronism was decreased by 0.56-fold. In contrast, when we set the cutoff point to Na/K< 3.0, the possibility of hyperaldosteronism decreased by 0.225-fold. In general, when screening for this disease, we should choose a lower negative likelihood test to avoid missing the disease. The Na/K ratio is~ 4.6 from the INTERSALT study in East Asians [1] or lower (2.0) from NIPPON DATA80