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南京医科大学学报(自然科学版) 第42卷第10期
·1426 · Journal of Nanjing Medical University(Natural Sciences) 2022年10月
·临床研究·
原发性醛固酮增多症筛查阳性率的现状研究
刘雨晴,王 敏,邱雪婷,马国栋,计铭钰,孙 敏 *
南京医科大学第一附属医院内分泌科,江苏 南京 210029
[摘 要] 目的:描述血浆醛固酮浓度(plasma aldosterone concentration,PAC)与醛固酮肾素活性比值(aldosterone to renin ratio,
ARR)的个体内变异,调查基于现行指南和专家共识推荐的 PAC 和 ARR 切点的原发性醛固酮增多症(primary aldosteronism,
PA)筛查阳性率现状。方法:从2017年4月—2021年3月南京医科大学第一附属医院内分泌科确诊的PA患者中选取具有在
不同日期2~4次PAC和ARR检测结果者80例,分析每个研究对象PAC和ARR的个体内变异系数(coefficient of variation,CV)
和百分比差异。使用指南推荐阈值:PAC < 10、15、20 ng/dL;ARR < 20、25、30(ng/dL)/[ng/(mL·h)],分别量化低于阈值的单次、
平均PAC以及ARR的PA患者占总人数的百分比。结果:80例研究对象共有182次立位血浆肾素活性(plasma rennin activity,PRA)
和PAC测量结果。PAC和ARR的CV为19.74%和26.11%;百分比差异为41.78%和52.22%。35.0%、75.0%、93.7%的研究对象
至少有1次PAC分别低于10、15、20 ng/dL;10.0%、37.5%、72.6%的研究对象至少有2次PAC分别低于10、15、20 ng/dL。17.5%、
26.3%、36.3%的研究对象至少有 1 次 ARR 分别低于 20、25、30(ng/dL)/[ng/(mL·h)];5.0%、6.3%、6.3%的研究对象至少有 2 次
ARR分别低于20、25、30(ng/dL)/[ng/(mL·h)]。结论:PA的PAC和ARR因多重因素影响,个体内变异大,单次筛查值低于指南
推荐阳性切点比例高,易致PA筛查假阴性率高。对疑似PA患者多次筛查及通过重新校准PA筛查的方法和切点,纳入更宽松
的PAC和ARR筛查阈值,有助于显著提高PA的诊断率。
[关键词] 原发性醛固酮增多症;醛固酮;血浆醛固酮肾素活性比值;个体变异
[中图分类号] R586.2 [文献标志码] A [文章编号] 1007⁃4368(2022)10⁃1426⁃06
doi:10.7655/NYDXBNS20221012
Research on present situation of positive rates screening for primary aldosteronism
LIU Yuqing,WANG Min,QIU Xueting,MA Guodong,JI Mingyu,SUN Min *
Department of Endocrinology and Metabolism,the First Affiliated Hospital of Nanjing Medical University,Nanjing
210029,China
[Abstract] Objective:To describe the intra⁃individual variation of plasma aldosterone concentration(PAC)and aldosterone to renin
ratio(ARR),and to investigate the current situation where positive rate of primary aldosteronism(PA)is based on cut⁃off values
guideline recommended. Methods:Eighty PA patients diagnosed in the Department of Endocrinology,the First Affiliated Hospital of
Nanjing Medical University from April 2017 to March 2021 who have 2~4 separated PAC and ARR results on different date were
enrolled to calculate the intra⁃individual coefficient of variation(CV)and percentage difference of PAC and ARR. The percentage of
PA patients with single average PAC and ARR below the recommended{PAC<10,15,20 ng/dL;ARR<20,25,30(ng/dL)/[ng/(mL·h)]}
were analyzed. Results:Totally 182 plasma rennin activity(PRA)and PAC measurements from 80 subjects were collected. CV of PAC
and ARR was 19.74% and 26.11% respectively,the percentage difference was 41.78% and 52.22%. 35.0%,75.0%,93.7% subjects
had at least one measurement of PAC lower than 10,15,20 ng/dL respectively;10.0%,37.5% and 72.6% subjects had at least twice PAC
lower than 10,15,20 ng/dL respectively. 17.5%,26.3%,36.3% subjects had at least one ARR lower than 20,25,30(ng/dL)/[ng/(mL·h)]
respectively;5.0% ,6.3% ,6.3% subjects had at least twice ARR lower than 20,25,30(ng/dL)/[ng/(mL · h)] respectively.
Conclusion:The PAC and ARR in PA vary greatly in individuals on account of multiple factors. The proportion of single screening
values below the positive cut ⁃ off values guideline recommended is relatively high,which may lead to false negative rate of PA
screening. For suspected patients,screening repeatedly,recalibrating PA screening cut⁃off point and bringing wider PAC and ARR
[基金项目] 江苏省青年医学重点人才项目(QNRC2016585)
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通信作者(Corresponding author),E⁃mail:drsunm@163.com