[Screening tests and diagnostic examinations of hypertensives for primary aldosteronism].
[Screening tests and diagnostic examinations of hypertensives for primary aldosteronism].
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原发性醛固酮增多症的高血压筛查试验和诊断检查。
DOI：
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
T. Nishikawa
中科院分区：
文献类型：
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作者：
M. Omura;T. Nishikawa
原发性醛固酮增多症(PA)是一种可通过手术治愈的继发性高血压。据报道，在高血压患者中，PA的患病率在5%到15%之间，PA患者中很少出现低钾血症。因此，应对高血压患者进行PA筛查。醛固酮(PAC)/肾素活性(PRA)比值(ARR)已被广泛用于PA的初步筛查，但有报道认为PA的诊断不应基于ARR升高的发现。我们比较了ARR与PAC、PRA对236例高血压患者筛选PA的敏感性和特异性，ROC分析显示PAC和PRA筛查PA的敏感性和特异性均高于ARR。回顾分析94例PA患者和44例非PA患者应用卡托普利抑制试验、速尿联合直立试验和ACTH刺激试验进行PA二次筛查的敏感性和特异性。ROC分析表明，ACTH刺激试验是这三种试验中最敏感和最特异的。因此，我们建议高血压患者应首先使用PAC和GT；或=12.0 ng/dl和PRA<；或=1.0 ng/ml/h的标准进行PA筛查，并应使用ACTH刺激试验进行二次筛查。ACTH刺激后最大PAC/皮质醇比值为0.85的患者应进行ACTH刺激后的肾上腺静脉采血。单侧分泌醛固酮2 1400 ng/dl的患者应行单侧肾上腺切除术，双侧分泌的醛固酮2 1400 ng/dl的患者应接受抗高血压药物治疗。
Primary aldosteronism (PA) is a form of surgically curable secondary hypertension. The prevalence of PA among hypertensive patients is reportedly between 5 and 15% and hypokalemia is rare in patients with PA. Therefore, hypertensives should be screened for PA. The aldosterone (PAC)-renin activity (PRA) ratio (ARR) has widely been used as the initial screening for PA; however, it is reported that the diagnosis of PA should not be based on the finding of a raised ARR. We compared the sensitivity and specificity of ARR for PA screening with those of PAC and PRA in 236 hypertensives, and ROC analysis revealed that PAC and PRA are more sensitive and specific than ARR for PA screening. The sensitivity and specificity of the captopril suppression test, furosemide plus upright test and ACTH stimulation test for secondary screening for PA were retrospectively examined in 94 patients with PA and 44 patients without PA. ROC analysis demonstrated that the ACTH stimulation test was the most sensitive and specific among these three tests. Therefore, we propose that hypertensives should initially be screened for PA using the criteria of PAC > or = 12.0 ng/dl and PRA < or = 1.0 ng/ml/h and should be secondarily screened using the ACTH stimulation test. Then ACTH-stimulated adrenal venous sampling should be performed in patients with the ratio of maximal PAC to cortisol after ACTH stimulation 0.85. Patients with unilateral secretion of aldosterone2 1400 ng/dl should undergo unilateral adrenalectomy and patients with bilateral secretion of aldosterone2 1400 ng/dl should be treated with antihypertensive agents.