摘要
目的:应用受试者工作特征曲线(ROC曲线)评估血浆醛固酮/肾素(ARR)在原发性醛固酮增多症(PA)和原发性高血压(EH)中的鉴别诊断效率,寻找最佳切点,利用联合ROC曲线寻找提高诊断效率的方法。方法:回顾性分析我院内分泌科病房2013-11~2017-11就诊给予明确诊断并存在高血压的PA病人81例及同期确诊的EH病人179例,收集所有病人的临床资料,绘制各指标ROC曲线,计算ROC曲线下面积(AUC),评估单项指标和联合指标的诊断效率,并寻找最佳切点及最佳筛查切点。结果:立位ARR最佳切点及最佳筛查切点均为3.2(ng·dL-1/ng·L-1),敏感性86.42%,特异性96.63%;立位血浆醛固酮(PAC)最佳切点及最佳筛查切点均为14.4ng/dL,敏感性83.95%,特异性73.60%。立位ARR和PAC的AUC分别为0.947、0.852。联合二者对PA与EH的鉴别效率最高,AUC为0.961,当该联合试验取最佳切点时,敏感性91.36%,特异性94.38%。结论:立位ARR对于筛查PA有着较高价值,最佳切点及最佳筛查切点均为3.2(ng·dL-1/ng·L-1),联合立位ARR和立位PAC可使试验效率进一步升高。
Objective:Objective This study aims to evaluate the differential diagnostic value of aldosterone to renin ratio(ARR) in primary aldosteronism(PA) and essential hypertension(EH) by applying the receiver operating characteristic(ROC)curve and to find out the optimal cut-off point of it, and to use combined ROC curve to improve the diagnosis efficiency. Methods:To retrospectively analyse the clinical data of 81 PA with hypertension and 179 EH during November 2013 to November 2017,and all these patients had clear diagnosises. To collect all the clinical data of these patients, evaluate the efficiency of diagnosis of individual and combinational index by the area under ROC curve(AUC), find the optimal cut-off point and the optimal cut-off point for screening. Results:The optimal cut-off point and the cut-off point for screening of upright ARR were all 3.2(ng·dL-1/ng·L-1), with a sensitivity of 86.42% and a specificity of 96.63%. The optimal cut-off point and the cut-off point for screening of upright PAC were all 14.4 ng/dL, with a sensitivity of 83.95% and a specificity of 73.60%. The AUC of upright ARR and PAC were 0.947 and 0.852.The combination of upright ARR and PAC had the highest efficiency of differential diagnosis for PA and EH, the AUC of it was 0.961, and when this combination was the optimal cut-off point, the sensitivity was 91.36% and the specificity was94.38%. Conclusion:ARR has a high value in screening PA. The optimal cut-off point and the cut-off point for screening of upright ARR were all 3.2(ng·dL-1/ng·L-1). The the combination of ARR and PAC can improve the efficiency of diagnosis.
作者
刘苗
闫朝丽
LIU Miao;YAN Zhao-li(Medical Examination Center,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050 China)
出处
《内蒙古医科大学学报》
2020年第2期131-134,144,共5页
Journal of Inner Mongolia Medical University
关键词
原发性醛固酮增多症
醛固酮/肾素比值
受试者工作特征曲线
最佳切点
primary aldosteronism
aldosterone to renin ratio
receiver operating characteristic curve
the optimal cut-off point
