APPLIED STUDY OF SCREENING SYSTEM FOR ADRENOCORTICAL HYPERTENSION

为了检测原发性醛固酮增多症（腺瘤）和遗传性糖皮质激素可治疗的醛固酮增多症，我们建立了一种基于单克隆抗体的18-羟基皮质醇荧光免疫分析法，使用化学合成的18-羟基皮质醇及其吖啶酯缀合物。该系统能够在15分钟内测量每管0.1至10 ng类固醇，或血清中2至200 ng/ml。我们还开发了一种基于滤纸的免疫测定法和一种基于凝胶基质的免疫测定法，用于方便的床边测量。原发性醛固酮增多症患者的血清18-羟皮质醇水平为10.6 × 3.5ng/ml，肾上腺切除术后降至2ng/ml以下。通过对261例高血压患者尿中18-羟基皮质醇的检测，筛选出2例18-羟基皮质醇水平最高的原发性醛固酮增多症（0.8%）。本研究中未发现糖皮质激素可治疗的醛固酮增多症，表明其在日本的发生率较低。然而，高尿18-羟皮质醇被证明是在一个既定的家庭与糖皮质激素可补救的醛固酮增多症。我们的结论是，我们的荧光免疫测定18-羟基皮质醇是有用的筛选肾上腺皮质高血压。

We established a monoclonal antibody-based chemiluminescent immunoassay for 18-hydroxycortisol, using chemically synthesized 18-hydroxycortisol and its acridinium ester-conjugate, in order to detect patients with primary aldosteronism (adenoma) and hereditary glucocorticoid-remediable aldosteronism. This system enabled measuring 0.1 to 10 ng steroid per tube, or 2 to 200nglml in serum) in 15 minutes. We also developed a filter paper-based immunoassay and also a gel matrix-based immunoassay for convenient bed-side measurement. Serum 18-hydroxycortisol levels in patients with primary aldosteronism were 10.6 * 3.5 ng/ml, and were lowered below 2 ng/ml after adrenalectomy. Urinary 18-hydroxycortisol in patients with hypertension (n=261) were screened for 18-hydroxycortisol by measuring the steroid in spot urine samples, and two with the highest 18-hydroxycortisol levels were diagnosed as primary aldosteronism (0.8%). Glucocorticoid-remediable hyperaldosteronism was not found in this study, suggesting its low frequency in Japan. However, a high urinary 18-hydroxycortisol was demonstrated in an established family with glucocorticoid-remediable hyperaldosteronism. We conclude that our chemiluminescent immunoassay for 18-hydroxycortisol is useful for screening adrenocortical hypertension.