开博通试验在原发性醛固酮增多症诊断中的价值
Application of captopril test in the diagnosis of primary aldosteronism
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摘要: 目的:探讨开博通试验在原发性醛固酮增多症诊断中的应用价值。方法:回顾性分析我院1993年1月~2006年12月收治的27例原发性醛固酮增多症患者和26例原发性高血压、16例原发性高血压合并肾上腺无功能瘤、3例肾上腺无功能瘤患者,比较50mg开博通试验的不同血浆醛固酮切点对原发性醛固酮增多症诊断的敏感性和特异性。结果:在50mg开博通试验中,以试验当日服用开博通2 h后血浆醛固酮抑制值超过基础值的20%以及服用开博通2 h后血浆醛固酮416 pmol/L、438 pmol/L、444 pmol/L为切点,诊断原发性醛固酮增多症的敏感性分别为96.3%、88.9%、88.9%、85.2%,特异性分别是13.3%、77.8%、82.2%、82.2%,随切点的升高,敏感性逐渐降低,特异性逐步提高。结论:开博通试验在诊断原发性醛固酮增多症中具有良好的应用价值,应根据自身实验室标准确定恰当的诊断切点。Abstract: Objective:To investigate the value of captopril test in the diagnosis of primary aldosteronism.Methods: 27 patients with primary aldosteronism and 26 patients with essential hypertension,16 patients with essential hypertension combined nonfunctional adrenal adenoma,3 patients with nonfunctional adrenal adenoma were studied in order to compare the sensitivity and specificity of different plasma aldosterone cut-off levels in captopril test in the diagnosis of primary aldosteronism.Results: The sensitivity by postcaptopril aldosterone reduction of more than 20% and of the plasma aldosterone cut-off levels of 416 pmol/L、 438 pmol/L、 444 pmol/L was 96.3%、 88.9%、 88.9% and 85.2% respectively,and the specificity was 13.3%、 77.8%、 82.2% and 82.2%,respectively.With increasing of plasma aldosterone cut-off levels,the specificity increased,but at the cost of a lower sensitivity.Conclusions: Captopril test represents a useful test to confirm the diagnosis of primary aldosteronism.The optimal cut-off level should be identified according to different laboratory reference value.
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