卡托普利抑制试验在原发性醛固酮增多症诊断和分型以及临床转归中的应用
R586.24; 背景 原发性醛固酮增多症(PA)作为继发性高血压中发病率最高、心脑血管危害大但手术后治愈率高的疾病,已被各大高血压指南推荐扩大筛查、早期诊断和治疗.但该类患者的确诊、分型和治疗后临床转归判定方式繁多且存在较多争议.卡托普利抑制试验(CCT)因其便捷、安全可直接用于社区、门诊,期望CCT能对PA患者进行全程管理以改善预后.目的 探究CCT对PA的诊断、分型以及临床转归的判断能力.方法 选取 2020-10-01-2022-12-30 在四川大学华西医院内分泌代谢科接受内分泌性高血压病因筛查并登记的 824 例患者为研究对象.经筛选后最终 370 例患者纳入研究,其中 123 例...
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| Published in | 中国全科医学 Vol. 27; no. 21; pp. 2592 - 2599 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
610041 四川省成都市,四川大学华西医院内分泌代谢科肾上腺疾病中心%563000 贵州省遵义市第一人民医院内分泌代谢科
20.07.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1007-9572 |
| DOI | 10.12114/j.issn.1007-9572.2023.0839 |
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| Abstract | R586.24; 背景 原发性醛固酮增多症(PA)作为继发性高血压中发病率最高、心脑血管危害大但手术后治愈率高的疾病,已被各大高血压指南推荐扩大筛查、早期诊断和治疗.但该类患者的确诊、分型和治疗后临床转归判定方式繁多且存在较多争议.卡托普利抑制试验(CCT)因其便捷、安全可直接用于社区、门诊,期望CCT能对PA患者进行全程管理以改善预后.目的 探究CCT对PA的诊断、分型以及临床转归的判断能力.方法 选取 2020-10-01-2022-12-30 在四川大学华西医院内分泌代谢科接受内分泌性高血压病因筛查并登记的 824 例患者为研究对象.经筛选后最终 370 例患者纳入研究,其中 123 例原发性高血压(EH)患者纳入EH组,247 例PA患者分别纳入单侧醛固酮瘤(APA)组 81 例、特发性醛固酮增多症(IHA)组 55 例和未分型PA(u-PA)组 111 例.比较 4 组间差异并绘制CCT后各指标及联合诊断PA的受试者工作特征(ROC)曲线,确定最佳截断值.其次绘制CCT后各指标诊断APA和IHA亚型的ROC曲线,计算ROC曲线下面积(AUC)评估CCT对APA和IHA的分型判断能力.最后根据术后临床结局将单侧肾上腺切除患者分为 3 组:未缓解组 11 例、临床改善组 27 例和临床缓解组 54 例,比较 3 组间差异并判断CCT对APA患者术后临床转归的判断能力.结果 CCT后血浆醛固酮浓度(PAC)对PA的诊断效能最高(AUC=0.921,95%CI=0.893～0.950),最佳截断值为11.7 ng/dL,灵敏度、特异度分别为84.6%和86.0%;CCT后醛固酮/肾素比值(ARR)对PA也有较好的诊断效能(AUC=0.868,95%CI=0.823～0.923),最佳截断值为 2.8(ng/dL)/(mU/L),灵敏度、特异度分别为 82.2%和 81.0%.CCT后PAC>17.0 ng/dL可协助诊断APA亚型,CCT后PAC<11.7 ng/dL同时ARR<2.8(ng/dL)/(mU/L)的患者可排除APA亚型.在接受手术治疗的患者中,有 87.2%患者经CCT后PAC<11.7 ng/dL,89.7%患者CCT后ARR<2.8(ng/dL)/(mU/L)均接近术后临床缓解水平(88.0%).结论 CCT可全程用于PA患者的诊断、分型和临床转归评价,CCT后PAC及CCT后ARR诊断PA |
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| AbstractList | R586.24; 背景 原发性醛固酮增多症(PA)作为继发性高血压中发病率最高、心脑血管危害大但手术后治愈率高的疾病,已被各大高血压指南推荐扩大筛查、早期诊断和治疗.但该类患者的确诊、分型和治疗后临床转归判定方式繁多且存在较多争议.卡托普利抑制试验(CCT)因其便捷、安全可直接用于社区、门诊,期望CCT能对PA患者进行全程管理以改善预后.目的 探究CCT对PA的诊断、分型以及临床转归的判断能力.方法 选取 2020-10-01-2022-12-30 在四川大学华西医院内分泌代谢科接受内分泌性高血压病因筛查并登记的 824 例患者为研究对象.经筛选后最终 370 例患者纳入研究,其中 123 例原发性高血压(EH)患者纳入EH组,247 例PA患者分别纳入单侧醛固酮瘤(APA)组 81 例、特发性醛固酮增多症(IHA)组 55 例和未分型PA(u-PA)组 111 例.比较 4 组间差异并绘制CCT后各指标及联合诊断PA的受试者工作特征(ROC)曲线,确定最佳截断值.其次绘制CCT后各指标诊断APA和IHA亚型的ROC曲线,计算ROC曲线下面积(AUC)评估CCT对APA和IHA的分型判断能力.最后根据术后临床结局将单侧肾上腺切除患者分为 3 组:未缓解组 11 例、临床改善组 27 例和临床缓解组 54 例,比较 3 组间差异并判断CCT对APA患者术后临床转归的判断能力.结果 CCT后血浆醛固酮浓度(PAC)对PA的诊断效能最高(AUC=0.921,95%CI=0.893～0.950),最佳截断值为11.7 ng/dL,灵敏度、特异度分别为84.6%和86.0%;CCT后醛固酮/肾素比值(ARR)对PA也有较好的诊断效能(AUC=0.868,95%CI=0.823～0.923),最佳截断值为 2.8(ng/dL)/(mU/L),灵敏度、特异度分别为 82.2%和 81.0%.CCT后PAC>17.0 ng/dL可协助诊断APA亚型,CCT后PAC<11.7 ng/dL同时ARR<2.8(ng/dL)/(mU/L)的患者可排除APA亚型.在接受手术治疗的患者中,有 87.2%患者经CCT后PAC<11.7 ng/dL,89.7%患者CCT后ARR<2.8(ng/dL)/(mU/L)均接近术后临床缓解水平(88.0%).结论 CCT可全程用于PA患者的诊断、分型和临床转归评价,CCT后PAC及CCT后ARR诊断PA |
| Abstract_FL | Background Primary hyperaldosteronism(PA)has been recommended by numerous hypertension guidelines to expand screening,early diagnosis and treatment,as a secondary hypertension disease with the highest incidence,great cardiovascular and cerebrovascular dangers but high cure rate after surgery.However,the diagnosis,classification and clinical outcomes evaluation of these patients are varied and controversial.Captopril challenge test(CCT)is expected to provide whole-course management for PA patients because it is convenient,safe and can be used directly in the community or outpatient clinic.Objective To explore the diagnostic efficacy,classification and biochemical remission assessment of CCT in patients with PA.Methods The study population consisted of 824 patients who completed the cause screening for hypertension and were enrolled in the Department of Endocrinology and Metabolism,West China Hospital,Sichuan University from October 1 th 2020 to December 30 th 2022.After screening,247 patients with PA and 123 patients with essential hypertension(EH)were enrolled,and PA was classified into aldosterone-producing adenoma(APA,81 patients),idiopathic hyperaldosteronism(IHA,55 patients),and uncategorized PA(u-PA,111 patients).The differences among the four groups were compared and the receiver operating characteristic(ROC)curve analysis showed the diagnostic performance for the prediction of PA.Secondly,the ROC curves of each post-CCT index for APA and IHA respectively were plotted.Finally,according to the postoperative clinical outcomes,the patients with unilateral adrenal resection were divided into three groups:clinical remission,clinical improvement,and no remission group.The difference between the three groups was compared,and the cut-off point of biochemical remission of CCT in APA patients was analyzed.Results The post-CCT plasma aldosterone concentration(PAC)level had the highest diagnostic efficiency for PA(AUC=0.921,95%CI=0.893-0.950),and the cut-off was 11.7 ng/dL.The sensitivity and specificity respectively was 84.6%and 86.0%.The post-CCT aldosterone to renin ratio(ARR)also had a good diagnostic efficacy for PA(AUC=0.868,95%CI=0.823-0.923).The cut-off was 2.8(ng/dL)/(mU/L),and the sensitivity and specificity respectively were 82.2%and 81.0%.The post-CCT PAC>17 ng/dL can assist in the diagnosis of APA subtypes.When post-CCT PAC<11.7 ng/dL combined with post-CCT ARR<2.8(ng/dL)/(mU/L),APA was almost excluded.The inhibition rate of PAC after CCT and the PAC remission rate after surgery were less effective in judging the biochemical remission assessment of APA,and post-CCT PAC<11.7 ng/dL or post-CCT ARR<2.8(ng/dL)/(mU/L)could better.Among the patients receiving surgical treatment,87.2%had post-CCT PAC<11.7 ng/dL,and 89.7%had post-CCT ARR<2.8(ng/dL)/(mU/L),which was close to the postoperative clinical remission level(88.0%).Conclusion CCT can be used throughout the diagnosis,classification and clinical outcomes evaluation of PA patients.post-CCT PAC 11.7 ng/dL and post-CCT ARR 2.8(ng/dL)/(mU/L)are good cut-off for the diagnosis,and can also be used for the classification of APA and the judgment of postoperative biochemical remission.Secondly,detection before CCT has little clinical significance and can simplify the process. |
| Author | 陈涛 谭璐 任艳 高洪蛟 陈彦希 |
| AuthorAffiliation | 610041 四川省成都市,四川大学华西医院内分泌代谢科肾上腺疾病中心%563000 贵州省遵义市第一人民医院内分泌代谢科 |
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| Author_FL | GAO Hongjiao CHEN Tao CHEN Yanxi REN Yan TAN Lu |
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| Keywords | 受试者工作特征曲线 Aldosterone to renin ratio Primary aldosteronism 单侧醛固酮瘤 Captopril Aldosterone-producing adenoma 卡托普利 原发性醛固酮增多症 卡托普利抑制试验 Captopril challenge test Receiver operating characteristic curve 醛固酮/肾素比值 |
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| Publisher | 610041 四川省成都市,四川大学华西医院内分泌代谢科肾上腺疾病中心%563000 贵州省遵义市第一人民医院内分泌代谢科 |
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| Title | 卡托普利抑制试验在原发性醛固酮增多症诊断和分型以及临床转归中的应用 |
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