■原发性醛固酮增多症(PA)的诊断由于需要停用会干扰检测结果的抗高血压药物而变得复杂,尤其是肾素。这项研究检查了基于机器学习的类固醇概率评分是否提供了一种与肾素测量无关的方法,用于测试比醛固酮与肾素比率(ARR)更不容易受到干扰。
■这项前瞻性多中心队列研究涉及在839名接受PA测试的患者中使用血浆类固醇组学和ARR,包括190和578没有PA(71不确定)。在使用和不使用干扰药物的情况下,检查了类固醇概率评分和ARR的接受者工作特征曲线。个别药物对血浆醛固酮的影响,18-氧皮质醇,18-羟基皮质醇,类固醇概率得分,肾素,通过多变量和配对分析对有和无PA患者的ARR进行了检查。
■受试者工作特征曲线表明,干扰抗高血压药物对ARR的诊断性能有显著影响,对类固醇概率评分的影响最小。盐皮质激素受体拮抗剂增加血浆醛固酮,18-氧皮质醇,和18-羟基皮质醇在没有PA的患者中,并导致类固醇概率评分的假阳性测试结果和ARR的假阴性结果。利尿剂增加醛固酮,18-氧皮质醇,和无PA患者的类固醇概率评分,而血管紧张素转换酶抑制剂降低醛固酮,类固醇概率得分,ARR。β-肾上腺素受体阻滞剂,二氢吡啶类钙通道阻滞剂,血管紧张素受体阻滞剂对盐皮质激素和类固醇概率评分的影响可忽略不计.
■在影响血浆醛固酮的抗高血压药物中,18-氧皮质醇,和18-羟基皮质醇,盐皮质激素受体拮抗剂是衍生类固醇概率评分假阳性结果的一个原因.其他抗高血压药影响很小或没有影响,当不能停用这些药物时,使用类固醇-概率评分优于ARR.
■URL:https://drks。de/;唯一标识符:DRKS00017084。
UNASSIGNED: Diagnosis of primary aldosteronism (PA) is complicated by the need to withdraw antihypertensive medications that interfere with test results, particularly renin. This study examined whether machine learning-based steroid-probability scores offer a renin measurement-independent approach for testing less prone to interference than the aldosterone-to-renin ratio (ARR).
UNASSIGNED: This prospective multicenter cohort study involved the use of plasma steroidomics and the ARR in 839 patients tested for PA, including 190 with and 578 without PA (71 indeterminate). Receiver operating characteristic curves for steroid-probability scores and the ARR were examined with and without interfering medications. Impacts of individual medications on plasma aldosterone, 18-oxocortisol, 18-hydroxycortisol, steroid-probability scores, renin, and ARRs were examined by multivariable and paired analyses in patients with and without PA.
UNASSIGNED: Receiver operating characteristic curves indicated a significant impact of interfering antihypertensive medications on the diagnostic performance of the ARR and minimal impact on steroid-probability scores. Mineralocorticoid receptor antagonists increased plasma aldosterone, 18-oxocortisol, and 18-hydroxycortisol in patients without PA and resulted in false-positive test results for steroid-probability scores and false-negative results for the ARR. Diuretics increased aldosterone, 18-oxocortisol, and steroid-probability scores in patients without PA, whereas angiotensin-converting enzyme inhibitors decreased aldosterone, steroid-probability scores, and ARRs. Beta-adrenoceptor blockers, dihydropyridine calcium channel blockers, and angiotensin receptor blockers had negligible impact on mineralocorticoids and steroid-probability scores.
UNASSIGNED: Among antihypertensive drugs that impact plasma aldosterone, 18-oxocortisol, and 18-hydroxycortisol, mineralocorticoid receptor antagonists stood out as a cause of false-positive results for derived steroid-probability scores. Other antihypertensives have minimal or no impact, an advantage for use of steroid-probability scores over the ARR when those medications cannot be withdrawn.
UNASSIGNED: URL: https://drks.de/; Unique identifier: DRKS00017084.