原发性醛固酮增多症患者血清NT-proBNP改变及临床意义研究

目的探讨原发性醛固酮增多症(PA)患者血清脑利钠肽前体N末端(NT-proBNP)改变及临床意义。方法纳入2012年1月至2015年12月疑似PA的高血压患者140例,分为PA组(n=30)和原发性高血压(EH)组(n=110)。检测两组患者血清NT-proBNP和肾素水平,并通过受试者工作特征曲线(ROC曲线)分析以及相关性分析比较血清NT-proBNP水平与PA的相关性。结果 PA组患者血清NT-proBNP水平[(93.9±7.3)pg/mL]明显高于EH组患者[(69.5±10.4)pg/mL],差异有统计学意义(P0.05)。单侧亚组PA患者肾素[(6.8±1.3)pg/mL vs.(5.1±0.6)pg/mL]、血浆醛固酮/血浆肾素比值(ARR)[(65.5±16.4)vs.(57.1±14.4)]和NT-proBNP[(101.9±14.1)pg/mL vs.(90.4±8.1)pg/mL]水平明显高于双侧亚组,差异均有统计学意义(P0.05)。NT-proBNP预测PA的AUC为0.809,95%CI:0.734~0.865,cut-off为98.4pg/mL,敏感度为83.4%,特异度为78.6%。预测单侧PA的AUC为0.733,95%CI:0.648~0.804,cut-off为109.6pg/mL,敏感度为79.9%,特异度为81.5%。血清NT-proBNP水平与ARR(r=0.765,P0.05)、PA(r=0.728,P0.05)和单侧PA(r=0.778,P0.05)呈正相关。结论 PA患者相比EH患者血清NT-proBNP水平轻度升高,有助于PA患者的早期诊断和筛查。

The clinical value of changes of serum NT-proBNP in patients with primary aldosteronism

Objective To evaluate the clinical value of changes of serum NT‐proBNP in patients with primary aldosteronism (PA) .Methods One‐hundreds and forty patients with PA were enrolled in this study and divided into two group :PA group (n=30) and essential hypertension (EH) group (n= 110) .The level of NT‐proBNP and renin were detected .The ROC analysis and cor‐relation analysis were used to estimate the association between serum NT ‐proBNP and PA .Results The levels of NT‐proBNP in PA group [(93 .9 ± 7 .3)pg/mL] were significantly higher than those in EH group [(69 .5 ± 10 .4)pg/mL] (P< 0 .05) .The levels of renin [(6 .8 ± 1 .3)pg/mL vs .(5 .1 ± 0 .6)pg/mL] ,plasma aldosterone‐to‐renin ratio (ARR) [(65 .5 ± 16 .4) vs .(57 .1 ± 14 .4)] and NT‐proBNP [(101 .9 ± 14 .1) pg/mL vs .(90 .4 ± 8 .1) pg/mL] in unilateral subgroup were all significantly higher than those in bilateral subgroup (P< 0 .05) .The AUC of NT‐proBNP for diagnosis of PA was 0 .809 ,95% CI :0 .734 - 0 .865 ,the cut‐off value was 98 .4 pg/mL ,and the specificity and sensitivity were 78 .6% and 83 .4% respectively .The AUC of NT‐proBNP for diagnosis of unilateral PA was 0 .733 ,and cut‐off value was 109 .6 pg/mL ,95% CI :0 .648 - 0 .804 ,and specificity and sensitivity were 81 .5%and 79 .9% respectively .In addition ,NT‐proBNP was positively correlated with ARR (r = 0 .765 ,P < 0 .05) ,PA (r = 0 .728 ,P<0 .05) and unilateral PA (r= 0 .778 ,P < 0 .05) .Conclusion In comparison with EH patients ,the levels of serum NT‐proBNP are slightly increased ,which may be helpful for PA early diagnosis .