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第42卷第10期 刘雨晴,王 敏,邱雪婷,等. 原发性醛固酮增多症筛查阳性率的现状研究[J].
2022年10月 南京医科大学学报(自然科学版),2022,42(10):1426-1431 ·1431 ·
ARR高度变异的现象无明显关联。 docrinol,2018,6(1):41-50
综上所述,本中心的描述性观察体现了真实临 [6] KÄYSER S C,DEKKERS T,GROENEWOUD H J,et al.
床实践中 PA 患者的 PAC 及 ARR 的高度变异性,提 Study heterogeneity and estimation of prevalence of pri⁃
示较高占比的患者一次筛查达不到基于现行指南 mary aldosteronism:a systematic review and Meta⁃regres⁃
sion analysis[J]. J Clin Endocrinol Metab,2016,101(7):
推荐的阳性阈值,从而可能漏诊 PA,因而无法早期
2826-2835
规避 PA 带来的危害。鉴于 PA 的高患病率、低诊断
[7] 中华医学会内分泌学分会,王卫庆. 原发性醛固酮增多
率,以及发生靶器官损害和心血管事件的高风险, 症诊断治疗的专家共识(2020版)[J]. 中华内分泌代谢
PA及时诊断意义重大。有学者提出倡议,对所有高 杂志,2020,36(9):727-736
[8]
血压患者至少进行一次PA筛查 。但是,面对庞大 [8] YOUNG W F. Diagnosis and treatment of primary aldoste⁃
的高血压患病人群,一方面PA筛查指标变异性大, ronism:practical clinical perspectives[J]. J Intern Med,
影响因素多,另一方面过于复杂的筛查前准备会显 2019,285(2):126-148
著降低临床医生的执行率。因此,如何高效提高PA [9] HUNG A,AHMED S,GUPTA A,et al. Performance of
筛查阳性率和准确性是一个巨大的挑战。规范采 the aldosterone to renin ratio as a screening test for prima⁃
ry aldosteronism[J]. J Clin Endocrinol Metab,2021,106
血前准备和标本检测前管理,标准化激素检测,对
(8):2423-2435
于降低检测带来的影响很重要。针对个体变异度
[10] BROWN J M,SIDDIQUI M,CALHOUN D A,et al. The
高的现象,在高度疑似 PA 人群中多次重复筛查也
unrecognized prevalence of primary aldosteronism:a cross⁃
是现阶段需要考虑的临床策略。同时,重新校准PA
sectional study[J]. Ann Intern Med,2020,173(1):10-
筛查的方法和纳入更宽松的PAC和ARR筛查阈值, 20
以助于显著提高 PA 的筛查诊断率更是十分重要。 [11] TANABE A,NARUSE M,TAKAGI S,et al. Variability in
随着对PA 及其亚型的病因和病理生理机制的深入 the renin/aldosterone profile under random and standard⁃
研究,未来有望发现新的生物学标志物以协助临床 ized sampling conditions in primary aldosteronism[J]. J
医生更高效准确地筛查和诊断PA。 Clin Endocrinol Metab,2003,88(6):2489-2494
[12] YOZAMP N,HUNDEMER G L,MOUSSA M,et al. Intra⁃
[参考文献]
individual variability of aldosterone concentrations in pri⁃
[1] FUNDER J W,CAREY R M,MANTERO F,et al. The mary aldosteronism:implications for case detection[J].
management of primary aldosteronism:case detection,di⁃ Hypertension,2021,77(3):891-899
agnosis,and treatment:an endocrine society clinical prac⁃ [13] YOZAMP N,HUNDEMER G L,MOUSSA M,et al. Vari⁃
tice guideline[J]. J Clin Endocrinol Metab,2016,101 ability of aldosterone measurements during adrenal ve⁃
(5):1889-1916 nous sampling for primary aldosteronism[J]. Am J Hyper⁃
[2] XU Z,YANG J,HU J,et al. Primary aldosteronism in pa⁃ tens,2021,34(1):34-45
tients in China with recently detected hypertension[J]. J [14] BYRD J B,TURCU A F,AUCHUS R J. Primary aldoste⁃
Am Coll Cardiol,2020,75(16):1913-1922 ronism:practical approach to diagnosis and management
[3] MONTICONE S,BURRELLO J,TIZZANI D,et al. Prev⁃ [J]. Circulation,2018,138(8):823-835
alence and clinical manifestations of primary aldosteron⁃ [15] VAIDYA A,CAREY R M. Evolution of the primary aldo⁃
ism encountered in primary care practice[J]. J Am Coll steronism syndrome:updating the approach[J]. J Clin En⁃
Cardiol,2017,69(14):1811-1820 docrinol Metab,2020,105(12):dgaa606
[4] DOUMA S,PETIDIS K,DOUMAS M,et al. Prevalence of [16] FU Y,GE S,QIU X,et al. Effect of sample delivery condi⁃
primary hyperaldosteronism in resistant hypertension:a tions on renin⁃angiotensin⁃aldosterone system(RAAS)as⁃
retrospective observational study[J]. Lancet,2008,371 say[J]. Scand J Clin Lab Invest,2020,80(4):336-342
(9628):1921-1926 [17] 郑枫凡,宋 颖,杨淑敏,等. 不同方法检测血醛固酮浓
[5] MONTICONE S,D’ASCENZO F,MORETTI C,et al. Car⁃ 度的一致性比较[J]. 中华内分泌代谢杂志,2019,35
diovascular events and target organ damage in primary al⁃ (11):934-938
dosteronism compared with essential hypertension:a sys⁃ [收稿日期] 2022-04-14
tematic review and meta⁃analysis[J]. Lancet Diabetes En⁃ (责任编辑:蒋 莉)