在高血压患者中采用尿钾/血钾平方比值及卧立位试验筛查原发性醛固酮增多症及进行分型诊断的临床价值

The clinical value of urinary potassium to serum potassium square ratio and supine-to-standing test for screening primary aldosteronism and subtype diagnosis in patients with hypertension

    摘要
  • 摘要:
    目的 探讨高血压患者的尿钾/血钾平方比值（UPPP）及卧立位试验对于原发性醛固酮增多症（PA）的筛查及分型诊断的临床价值。
    方法 本研究是一项回顾性研究。收集2020年1月至2023年8月河南省人民医院 60例PA患者和60例年龄、性别、体重指数匹配的原发性高血压（EH）患者的临床资料，通过静脉盐水负荷试验（ISLT）诊断PA。比较两组临床资料、尿钾/血钾比值（UPP）、UPPP。分析UPP和UPPP与卧位和立位血浆醛固酮与肾素比值（ARR）的相关性。利用受试者操作特征（ROC）曲线评价卧位和立位ARR、UPP、UPPP筛查PA的效能及卧立位试验对PA分型诊断的临床价值。
    结果 PA患者的血钠、尿钾、UPP、UPPP、卧位和立位血浆醛固酮浓度（PAC）、卧位和立位ARR高于EH患者（均P＜0.05），而血钾、卧位和立位血浆肾素活性（PRA）低于EH组（P＜0.05）。UPPP与卧位和立位ARR高度相关（rs=0.980，0.905，均P＜0.001）。卧位ARR（AUC：0.989）与立位ARR（AUC：0.991）筛查PA的效能差异无统计学意义（Z=0.643，P=0.520）；UPPP（AUC：0.938）的筛查效能低于卧位ARR（AUC：0.989）与立位ARR（AUC：0.991）（Z=2.841，2.816；P=0.005，0.005），但高于UPP（AUC：0.881）（Z=4.185，P＜0.001）。当UPPP＞3.42时，筛查PA的灵敏度为91.67 %，特异度为90.00 %。卧立位试验PAC增加百分比≤30%的患者对于醛固酮瘤（APA）的诊断率为100 %，而对于PAC增加百分比＞30%的患者，尚不能肯定是特发性醛固酮增多症。
    结论 卧位和立位ARR筛查PA的价值差异无统计学意义；UPPP与卧位和立位ARR呈高度相关，筛查价值低于卧位和立位ARR，优于UPP，具有较高的灵敏度和特异度；卧立位试验PAC增加百分比≤30 %对于APA的诊断有一定的价值。

     

    Abstract:
    Objective To investigate the clinical value of urinary potassium to serum potassium square ratio (UPPP) and supine-to-standing test for screening primary aldosteronism (PA) and distinguishing PA subtype in patients with hypertension.
    Methods This study was a retrospective analysis. The clinical data of 60 patients with primary aldosteronism (PA) (PA group) and 60 age, gender and body mass index-matched patients with essential hypertension (EH) from Henan Provincial People's Hospital from January 2020 to August 2023 were collected. PA was diagnosed by intravenous saline stress test (ISLT). The clinical data, urine potassium to blood potassium ratio (UPP) and UPPP were compared between the two groups. The correlations between UPP, UPPP and plasma aldosterone to renin activity ratio (ARR) in supine and standing positions were analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the efficacy of ARR, UPP and UPPP in supine and upright positions in screening PA and the clinical value of supine and upright position test in the subtype diagnosis of PA.
    Results  The levels of serum sodium, 24 h urinary potassium, UPP, UPPP, supine PAC, supine ARR, upright PAC and upright ARR in PA group were higher than those in EH group (all P＜0.05). The serum potassium and PRA in supine and upright in PA group were lower than those in EH group (P＜0.05). UPPP was highly correlated with supine or upright ARR (rs=0.980, 0.905, all P＜0.001). The efficiency of supine ARR (AUC:0.989) for screening PA was similar to that of upright ARR (AUC:0.991) (Z=0.643, P=0.520). The efficiency of UPPP (AUC: 0.938) for screening PA was lower than that of supine ARR (AUC:0.989) and upright ARR (AUC:0.991) (Z=2.841, 2.816; P=0.005, 0.005). The efficiency of UPPP was higher than that of UPP (AUC: 0.881) (Z=4.185, P＜0.001). The sensitivity of UPPP for screening PA was 91.67%, and the specificity was 90.00%. The diagnostic rate of aldosterone- producing adenoma (APA) was 100% when the percentage of PAC increase in the supine position test was ≤ 30%, while patients with a PAC increase percentage greater than 30% cannot be definitively diagnosed with idiopathic aldosteronism.
    Conclusions The value of supine ARR and upright ARR for screening PA is equivalent; UPPP is highly correlated with supine and upright ARR. The screening value of UPPP is slightly lower than that of supine and upright ARR, and better than that of UPP, it has higher sensitivity and specificity. PAC increase percentage ≤30% in the supine position test has a certain value for the diagnosis of APA.

     

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