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目的探讨性别对血浆醛固酮/肾素活性比值(PAC/PRA,ARR)在原发性醛固酮增多症(简称原醛症)筛查中的价值的影响。方法搜集1992-2014年在解放军总医院确诊的451例原醛症及300例原发性高血压(EH)患者的临床资料,根据性别进行分组,比较组间临床特点及生化指标,利用受试者工作特征曲线(ROC)寻找不同性别ARR的最佳诊断切点。结果原醛症患者血浆醛固酮、血钠及ARR明显高于EH患者(P<0.01),但血浆肾素活性(PRA)、血钾及体重指数(BMI)明显低于EH患者(P<0.01),两组年龄、高血压病程及血压水平无明显差异(P>0.05)。无论在原醛症或EH患者中,男性PRA均明显低于女性,但立位醛固酮未见明显差异(P>0.05)。男性患者中筛查原醛症的最佳ARR切点为19.11,曲线下面积(AUC)为0.968,敏感性为92.44%,特异性为93.08%,约登指数(YI)为0.86;女性患者中ARR最佳诊断切点为27.26,AUC为0.956,敏感性为92.07%,特异性为90.00%,YI为0.82。当根据总体人群最佳切点调整男性或女性ARR值时,二者YI均下降。男性最佳ARR切点要小于现阶段国内外指南推荐范围。结论性别是影响利用ARR筛查原醛效率的重要因素,应考虑设立性别相关的切点,女性最佳切点可能高于男性。
Objective To investigate the effect of sex on the value of plasma aldosterone / renin activity ratio (PAC / PRA, ARR) in the screening of primary aldosteronism. Methods The clinical data of 451 cases of primary aldosteronism and 300 cases of essential hypertension (EH) diagnosed in People’s Liberation Army General Hospital from 1992 to 2014 were collected and divided into groups according to their gender. The clinical characteristics and biochemical indexes of the patients were compared. Personality Trait (ROC) to find the best diagnostic cutoff for ARR of different genders. Results The plasma aldosterone, serum sodium and ARR in patients with primary aldosteronism were significantly higher than those in patients with EH (P <0.01), but plasma renin activity (PRA), serum potassium and body mass index (BMI) There was no significant difference between the two groups in age, duration of hypertension and blood pressure (P> 0.05). There was no significant difference in urinary aldosterone between the two groups (P> 0.05). The best ARR cutoff point for screening primary aldosteron was 19.11 in male patients, the area under the curve (AUC) was 0.968, the sensitivity was 92.44%, the specificity was 93.08%, and the Youden index (YI) was 0.86. Among the female patients The best diagnostic cutoff point of ARR was 27.26, AUC was 0.956, sensitivity was 92.07%, specificity was 90.00%, YI was 0.82. When adjusting the male or female ARR based on the optimal cut point for the overall population, both YI decreased. Male best ARR cut point is less than the current recommended range of guidelines at home and abroad. Conclusions Gender is an important factor influencing the efficiency of ARR screening of primary aldehydes. Sex-related cut-off points should be considered. The best cut-off point for females may be higher than that of males.