作　　者： ; ; ; ; ; ; ; ;

机构地区： 北京协和医学院

出　　处： 《中华检验医学杂志》 2020年第3期261-266,共6页

摘　　要： 目的:探讨液相色谱串联质谱法检测尿醛固酮在原发性醛固酮增多症筛查中的临床应用价值。方法:诊断性能评价。选取2019年1月到10月间符合入组标准的住院患者413例,其中原发性醛固酮增多症(PA)患者60例,原发性高血压患者353例。测定立位2 h血浆醛固酮浓度(PAC)及肾素浓度(DRC),留取24 h尿液采用液相色谱串联质谱法(LC-MS/MS)检测尿醛固酮。通过绘制受试者工作特征曲线(ROC)评估尿醛固酮及尿醛固酮与肾素浓度比值(UADRR)在筛查PA中的价值,并与血浆醛固酮肾素浓度比值(ADRR)筛查PA的结果进行比较,同时考察尿钠大于200 mmol/24 h、老年患者或低血钾患者中尿醛固酮在筛查PA中的应用价值。结果:LC-MS/MS检测尿醛固酮的ROC曲线下面积为0.725(95%CI 0.679~0.767),最佳切点为7.13μg/24 h,低于ADRR的ROC曲线下面积(0.958,95%CI 0.934~0.975)。UADRR的ROC曲线下面积为0.947(95%CI 0.920~0.966),最佳切点为1.11(μg/24 h)/(μIU/ml),敏感度和特异度分别为91.7%和89.0%,与ADRR无统计学差异。当24 h尿钠含量大于200 mmol时,尿醛固酮的ROC曲线下面积为0.834(95%CI 0.730~0.910),最佳切点值为9.31μg/24 h,该切点下敏感度和特异度分别为90.9%和68.7%。对于60岁以上老年患者,尿醛固酮的ROC曲线下面积为0.860(95%CI 0.770~0.925),最佳切点值为6.91μg/24 h,该切点下敏感度和特异度分别为84.6%和81.3%。当入院血钾水平小于3.50 mmol/L时,尿醛固酮的ROC曲线下面积为0.822(95%CI 0.684~0.917),最佳切点值为10.63μg/24 h,该切点下敏感度和特异度分别为85.7%和66.7%。结论:LC-MS/MS检测尿醛固酮可为临床筛查PA提供参考,且在24 h尿钠大于200 mmol、老年患者或低血钾患者中筛查性能更优,若联合肾素浓度检测可提供与ADRR相当的筛查价值。 Objective To explore the clinical utility of liquid chromatography tandem mass spectrometry forprimary aldosteronism screening.Methods From January to October 2019,413 inpatients diagnosed hypertension from Fuwai Hospital of Chinese Academy of Medical Sciences were enrolled,including 60 Primary aldosteronism(PA)patients and 353 primary hypertension patients.The plasma aldosterone concentration(PAC)and renin concentration(DRC)were measured after 2 h of standing.The 24 h urine samples were collected for measurement of aldosterone using LC-MS/MS.The performance of urine aldosterone and urine aldosterone/renin ratio(UADRR)in PA screening was evaluated by ROC,and compared with PAC/DRC ratio(ADRR).Meanwhile,the efficiency of urine aldosterone in elderly patients or patients with low blood potassium or 24 h urine sodium over 200 mmol was investigated.Results Area under the curve(AUC)of urine aldosterone was 0.725(95%CI 0.679-0.767),and the best cut-off was 7.13μg/24 h,which was lower than AUC of ADRR(0.958,95%CI 0.934-0.975).The AUC of UADRR was 0.947(95%CI 0.920-0.966),the best cut-off was 1.11(μg/24 h)/(μIU/ml),the sensitivity and specificity were 91.7%and 89.0%,respectively.There is no significant differences found with ADRR.In patients with 24 h urine sodium over 200 mmol,AUC of aldosterone was 0.834(95%CI 0.730-0.910)and the best cut-off was 9.31μg/24 h.The sensitivity and specificity were 90.9%and 68.7%,respectively.For the elderly patients over 60 years old,the AUC of urinary aldosterone was 0.860(95%CI 0.770-0.925),and the best cut-off was 6.91μg/24 h.The sensitivity and specificity were 84.6%and 81.3%,respectively.When admission blood potassium was less than 3.50 mmol/L,AUC of urinary aldosterone was 0.822(95%CI 0.684-0.917),and the best cut-off was 10.63μg/24 h.The sensitivity and specificity were 85.7%and 66.7%,respectively.Conclusion The detection of aldosterone in urine by LC-MS/MS can provide clinical information for PA screening,and the screening performance is better in patients with 24-hour urine

关 键 词： 醛固酮增多症 醛固酮 尿分析 串联质谱法 色谱法 液相

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