口服盐负荷联合体位刺激试验确定原发性醛固酮增多症并分型。

IF 3.7 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY
Jenny Yeuk Ki Cheng, Wai Shan Clara Lo, Teresa Kam Chi Tsui, Wing Kar Edith Chow, Kitty Kit Ting Cheung, Ronald Ching Wan Ma, Risa Ozaki, Chung Shun Ho
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引用次数: 0

摘要

目的:原发性醛固酮增多症(PA)是一种未被诊断的重要疾病。本研究旨在评估使用口服盐负荷和体位刺激试验(PST)的联合方案的诊断性能,称为平衡研究,以确认和分型PA。方法:我们回顾性分析了402例确诊为PA或原发性高血压的患者进行平衡研究的资料。采用液相色谱-串联质谱法测定生化标志物。采用受试者工作特征曲线评价诊断效果。生化指标的截止值采用Youden J的统计方法确定。结果:尿醛固酮(UALD;曲线下面积[AUC] 0.894),尿四氢醛固酮(UTHA;AUC 0.875), UALD与UTHA之和(sum;AUC 0.884),仰卧位血浆醛固酮(PALD;AUC 0.902)表现出相当的性能。相应的截止值为:UALD >8 nmol/day, UTHA>160 nmol/day, SUM>259 nmol/day,仰卧位PALD>273 pmol/L。对于PA亚型,直立和仰卧PALD在PST上的差异或比值达到0.90的AUC。从仰卧位到直立位增加小于19 pmol/L或小于5 %提示醛固酮产生腺瘤。结论:使用口服盐负荷和PST的联合方案有助于确认PA的诊断和预测亚型。UTHA和仰卧位PALD可以增加UALD对PA确认的价值,而PST的直立/仰卧位PALD比值可以帮助PA分型。需要进一步的研究来验证这些发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Oral salt loading combined with postural stimulation tests for confirming and subtyping primary aldosteronism.

Objectives: Primary aldosteronism (PA) is an underdiagnosed yet important condition. This study aimed to evaluate the diagnostic performance of a combined protocol using oral salt loading and postural stimulation tests (PST), named the balance study, to confirm and subtype PA.

Methods: We retrospectively analyzed the data of 402 patients with either confirmed PA or essential hypertension who underwent the balance study. Biochemical markers were measured using liquid chromatography-tandem mass spectrometry. Receiver operating characteristic curves were used to assess the diagnostic performance. The cut-off values for biochemical markers were determined by Youden J's statistics.

Results: For PA confirmation, urinary aldosterone (UALD; area under the curve [AUC] 0.894), urinary tetrahydroaldosterone (UTHA; AUC 0.875), the sum of UALD and UTHA (SUM; AUC 0.884), and supine plasma aldosterone (PALD; AUC 0.902) showed comparable performance. Corresponding cut-offs were: UALD>38 nmol/day, UTHA>160 nmol/day, SUM>259 nmol/day, and supine PALD>273 pmol/L. For PA subtyping, the difference or ratio between erect and supine PALD in PST achieved an AUC of 0.90. An increase of less than 19 pmol/L or less than 5 % from a supine to an erect position suggested an aldosterone-producing adenoma.

Conclusions: This combined protocol using oral salt loading and PST could help confirm a diagnosis of PA and predict the subtype. UTHA and supine PALD may add value to UALD for PA confirmation, whereas the erect/supine PALD ratio from PST could assist in PA subtyping. Further studies are required to validate these findings.

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来源期刊
Clinical chemistry and laboratory medicine
Clinical chemistry and laboratory medicine 医学-医学实验技术
CiteScore
11.30
自引率
16.20%
发文量
306
审稿时长
3 months
期刊介绍: Clinical Chemistry and Laboratory Medicine (CCLM) publishes articles on novel teaching and training methods applicable to laboratory medicine. CCLM welcomes contributions on the progress in fundamental and applied research and cutting-edge clinical laboratory medicine. It is one of the leading journals in the field, with an impact factor over 3. CCLM is issued monthly, and it is published in print and electronically. CCLM is the official journal of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and publishes regularly EFLM recommendations and news. CCLM is the official journal of the National Societies from Austria (ÖGLMKC); Belgium (RBSLM); Germany (DGKL); Hungary (MLDT); Ireland (ACBI); Italy (SIBioC); Portugal (SPML); and Slovenia (SZKK); and it is affiliated to AACB (Australia) and SFBC (France). Topics: - clinical biochemistry - clinical genomics and molecular biology - clinical haematology and coagulation - clinical immunology and autoimmunity - clinical microbiology - drug monitoring and analysis - evaluation of diagnostic biomarkers - disease-oriented topics (cardiovascular disease, cancer diagnostics, diabetes) - new reagents, instrumentation and technologies - new methodologies - reference materials and methods - reference values and decision limits - quality and safety in laboratory medicine - translational laboratory medicine - clinical metrology Follow @cclm_degruyter on Twitter!
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