评价卡托普利试验诊断原发性醛固酮增多症的价值

发布时间：2018-01-08 16:22

本文关键词：评价卡托普利试验诊断原发性醛固酮增多症的价值　出处：《中国循环杂志》2016年08期 　论文类型：期刊论文

【摘要】：目的:评价卡托普利试验对于原发性醛固酮增多症的诊断意义,并计算最佳诊断切点。方法:1994-06至2012-05期间解放军总医院内分泌科收治的96例综合临床表现、实验室检查及辅助检查明确诊断为原发性醛固酮增多症患者为原发性醛固酮增多症组,同时收集45例高度怀疑原发性醛固酮增多症,并经生化检查、辅助检查及功能试验检查结果排除原发性醛固酮增多症,被诊断为原发性高血压的患者为原发性高血压组。住院期间患者均行卡托普利试验,并应用受试者工作特征(ROC)曲线对卡托普利试验的醛固酮水平及试验后醛固酮与肾素水平进行评价,分析其诊断效能,并得出最佳诊断切点及对应的敏感性和特异性。结果 :卡托普利试验后1 h、2 h的醛固酮水平的ROC曲线下面积(AUC)为0.831和0.818,试验后1 h、2 h的醛固酮与肾素比值的AUC分别是0.909和0.922;试验后1 h醛固酮水平的切点为544.95 pmol/L,敏感性为70%,特异性为90.7%,试验后2 h醛固酮水平的切点为466.8 pmol/L,敏感性为69.8%;特异性为70.5%;试验后1 h醛固酮与肾素比值的切点为34.6[ng/dl:μg/(ml·h)],敏感性78.3%;特异性88.4%。试验后2 h醛固酮与肾素比值的AUC最大,该指标有较高的诊断价值,诊断切点为42.2[ng/dl:μg/(ml·h)],敏感性和特异性分别为76.7%和95.3%。结论:卡托普利试验后1 h、2 h后醛固酮水平及醛固酮与肾素的比值均对原发性醛固酮增多症有诊断价值,以卡托普利试验后2 h醛固酮与肾素比值的诊断价值最大。
[Abstract]:Objective: to evaluate the diagnostic value of captopril test for primary aldosteronism. Methods 96 cases admitted to the Department of Endocrinology of the General Hospital of PLA from June 1994 to May 2012 were analyzed. Laboratory examination and auxiliary examination confirmed that the patients with primary aldosteronism were diagnosed as primary aldosteronism group. At the same time, 45 cases of highly suspected primary aldosteronism were collected and biochemical examination. The results of auxiliary examination and functional test excluded essential aldosteronism. The patients diagnosed as essential hypertension were treated with captopril test. The aldosterone level of captopril test and the levels of aldosterone and renin after captopril test were evaluated by using the operating characteristics of subjects and the diagnostic efficacy was analyzed. The optimal diagnostic point, sensitivity and specificity were obtained. Results: 1 h after captopril test. The area under the ROC curve of aldosterone level for 2 h was 0.831 and 0.818 respectively. The AUC of aldosterone to renin ratio at 2 h was 0.909 and 0.922, respectively. The cutting point of aldosterone level was 544.95 pmol / L, the sensitivity was 70 and the specificity was 90.7%. 2 h after the trial, the cutting point of aldosterone level was 466.8 pmol / L, and the sensitivity was 69.8 pmol / L; The specificity was 70.5; The ratio of aldosterone to renin was 34.6 at 1 h after the trial. [Ng / dl: 渭 g / ml 路h], sensitivity 78.3; The ratio of aldosterone to renin was the largest in AUC at 2 h after the test. The diagnostic value of this index was high, and the diagnostic cut-off point was 42.2. [The sensitivity and specificity were 76.7% and 95.3, respectively. Conclusion: 1 h after captopril test. The level of aldosterone and the ratio of aldosterone to renin were valuable in the diagnosis of primary aldosteronism 2 h after captopril test.
【作者单位】：中国人民解放军总医院老年科;
【分类号】：R586.24
【正文快照】： 卡托普利抑制试验是临床应用最广泛的原发性醛固酮增多症的确诊试验之一。正常情况下,卡托普利可以抑制血管紧张素转换酶,减少血管紧张素Ⅱ产生,即使在肾素水平很高的情况下,也可以抑制醛固酮分泌。但对于自主性分泌醛固酮的原发性醛固酮增多症患者,卡托普利对醛固酮无明显抑

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