Abstract：
We investigated the clinical characteristics of primary aldosteronism (PA) screened from patients with hypertension in China. The participants were hypertensive patients who were suspected of PA and registered in the China Primary Aldosteronism Prospective Study. Plasma aldosterone-to-renin ratio (ARR) was used as the screening test. In patients screened positive for PA, that is, an ARR exceeding the thresholds and plasma aldosterone concentration (PAC) > 100 pg/mL, a confirmatory test was performed for diagnosis. Patients with PA underwent a CT scan and adrenal venous sampling for subtyping. Of the 1497 screened patients, 754 (50.4%) had an ARR exceeding the diagnostic threshold and 637 (84.5% of those eligible) were registered. These registered hypertensive patients with suspected PA had a mean (standard deviation) age of 52.6 ± 12.1 years, and included 442 (58.6%) women. In multiple stepwise logistic regression, the significant odds ratios for the presence of diagnosed (n = 490) versus suspected and non-diagnosed PA (n = 147) were 4.54 (95% CI: 2.78-7.39) for a history of hypokalemia, 0.79 (95% CI: 0.64-0.98) for a 0.9 mmol/l higher serum total cholesterol, and 2.25 (95% CI: 1.63-3.10) for a doubling of PAC in the supine or standing/sitting position. In multiple stepwise logistic regression, the significant odds ratios for the presence of unilateral (n = 135) versus bilateral PA (n = 53) were 3.04 (95% CI: 1.90-4.87) for a 0.4 mmol/l lower minimum serum potassium concentration and 1.86 (95% CI: 1.20-2.86) for a 0.3 mmol/l higher serum high-density lipoprotein cholesterol. PA might be a biochemical continuum in the adrenal hypersecretion of aldosterone as well as hypokalemia.
摘要：
我们调查了从中国高血压患者中筛查的原发性醛固酮增多症（PA）的临床特征。参与者是怀疑患有PA并在中国原发性醛固酮增多症前瞻性研究中注册的高血压患者。使用血浆醛固酮与肾素比率（ARR）作为筛选测试。在PA筛查阳性的患者中，也就是说,ARR超过阈值和血浆醛固酮浓度（PAC）>100pg/mL，进行了验证性测试以进行诊断。PA患者接受了CT扫描和肾上腺静脉采样以进行分型。在1497名接受筛查的患者中，754例(50.4%)的ARR超过诊断阈值，637例(84.5%的符合条件的人)登记。这些登记的疑似PA的高血压患者的平均（标准差）年龄为52.6±12.1岁，其中包括442名(58.6%)女性。在多元逐步逻辑回归中，对于低钾血症病史，诊断的PA（n=490）与可疑和未诊断的PA（n=147）的显着比值比为4.54（95％CI：2.78-7.39），0.79（95%CI：0.64-0.98）为0.9mmol/l血清总胆固醇，和2.25（95％CI：1.63-3.10）为仰卧或站立/坐姿的PAC加倍。在多元逐步逻辑回归中，对于低0.4mmol/l的最低血清钾浓度,单侧PA(n=135)与双侧PA(n=53)的显著比值比为3.04(95%CI:1.90~4.87),对于高0.3mmol/l的血清高密度脂蛋白胆固醇,显著比值比为1.86(95%CI:1.20~2.86).PA可能是肾上腺醛固酮分泌过多和低钾血症的生化连续体。
