Potential effects of age on screening for primary aldosteronism
Potential effects of age on screening for primary aldosteronism
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DOI：
10.1038/jhh.2015.21
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发表时间：
2016-01-01
影响因子：
2.7
通讯作者：
Jia, Y.
中科院分区：
文献类型：
--
作者：
Luo, Q.;Li, N-F;Jia, Y.
醛固酮/肾素比值（ARR）目前被认为是原发性醛固酮增多症（PA）最可靠、最有效的筛查方法，然而，随着年龄的增长，ARR的准确性不断下降，这对老年人群的PA筛查构成了重大挑战。为了阐明年龄对前列腺癌筛查的潜在影响，我们招募了216名前列腺癌患者和657名非前列腺癌患者，并将其细分为4个年龄组（均为60岁），比较了他们的生化参数。正如预期的那样，在非PA组中，血浆肾素活性（PRA）比血浆醛固酮浓度（PAC）降低得更多，并导致ARR随着年龄的增加而逐渐升高（P < 0.001），而在PA组中，这种现象并不明显。>= 50岁患者PA筛查ARR的最佳临界值升高，而ARR的受者工作特征曲线下面积（AUC）、灵敏度、特异性和约登指数（YI）随着年龄的增加而下降，尤其是>= 60岁患者（AUC = 0.863，灵敏度= 95.2%，特异性= 69.0%,YI = 0.643）。PAC的AUC随着年龄的增长而增加，在bb0 = 60岁的患者中，AUC（PAC）略高于ARR （AUC(PAC) = 0.884）。我们的数据表明，>= 50岁患者PA筛查的ARR标准可能需要设定更高；随着年龄的增长，特别是在bb0 = 60岁的患者中，可以通过在中心适用时考虑PAC的绝对值来提高ARR下降的准确性。
Aldosterone/renin ratio (ARR) is currently regarded as the most reliable and available screening test for primary aldosteronism (PA), however, the falling accuracy of ARR with increasing age has posed crucial challenge for PA screening among older-aged population. To clarify potential effects of age on screening for PA, 216 subjects with PA and 657 subjects with non-PA were recruited and subdivided into four age groups (= 60 years) and their biochemical parameters were compared. As expected, plasma renin activity (PRA) lowered more than plasma aldosterone concentration (PAC) and led to gradually elevated ARR with increasing age in the non-PA group (P < 0.001), whereas this phenomenon was unconspicuous in the PA group. The best cut-off values of ARR for PA screening were elevated in subjects >= 50 years, whereas the area under the receiver operating characteristic curves (AUCs), sensitivity, specificity and Youden's index (YI) of ARR were declined with increasing age, especially in patients >= 60 years (AUC = 0.863, sensitivity = 95.2%, specificity = 69.0%, YI = 0.643). The AUCs of PAC increased with increasing age and even slightly surpassed that of ARR in patients >= 60 years (AUC(PAC) = 0.884). Our data suggest that the criteria of ARR for PA screening in patients >= 50 years may need setting higher; the falling accuracy of ARR with increasing age, especially in patients >= 60 years, could be improved by taking into account the absolute value of the PAC when applicable by the center.