化学发光法和放射免疫法对原发性醛固酮增多症的诊断效果比较

洪阳宁; 孙芳; 张和轩; 刘小丽; 赵志钢; 何洪波; 闫振成; 祝之明

doi:10.16016/j.1000-5404.201906209

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化学发光法和放射免疫法对原发性醛固酮增多症的诊断效果比较

临床医学 | 更新时间：2026-01-09

- 化学发光法和放射免疫法对原发性醛固酮增多症的诊断效果比较
- Diagnostic efficacy of chemiluminescence immunoassay versus radioimmunoassay in screening primary aldosteronism
- 第三军医大学学报 2019年第21期页码：2080-2086
- 作者机构：
  
  400042 重庆，陆军军医大学(第三军医大学)大坪医院高血压内分泌科，全军内分泌代谢病中心，重庆市高血压研究所
- 作者简介：
  
  [ 祝之明，E-mail:zhuzm@yahoo.com ZHU Zhiming, E-mail:zhuzm@yahoo.com
- 基金信息：
  
  国家自然科学基金面上项目(81370944);陆军军医大学临床医学科研人才培养计划基金(2018XLC1011)
- DOI：10.16016/j.1000-5404.201906209
  中图分类号： R446.1;R446.6;R586.24
- 收稿：2019-06-25，
  
  修回：2019-08-24，
  
  纸质出版：2019-11-15
- 稿件说明：
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洪阳宁, 孙芳, 张和轩, 等. 化学发光法和放射免疫法对原发性醛固酮增多症的诊断效果比较[J]. 第三军医大学学报, 2019,(21):2080-2086.

Yangning HONG, Fang SUN, Hexuan ZHANG, et al. Diagnostic efficacy of chemiluminescence immunoassay versus radioimmunoassay in screening primary aldosteronism[J]. Journal of Third Military Medical University, 2019, (21): 2080-2086.
洪阳宁, 孙芳, 张和轩, 等. 化学发光法和放射免疫法对原发性醛固酮增多症的诊断效果比较[J]. 第三军医大学学报, 2019,(21):2080-2086. DOI： 10.16016/j.1000-5404.201906209.

Yangning HONG, Fang SUN, Hexuan ZHANG, et al. Diagnostic efficacy of chemiluminescence immunoassay versus radioimmunoassay in screening primary aldosteronism[J]. Journal of Third Military Medical University, 2019, (21): 2080-2086. DOI： 10.16016/j.1000-5404.201906209.

摘要

目的

比较化学发光法和放射免疫法检测醛固酮与肾素的敏感性、特异性，探索筛查原发性醛固酮增多症的最佳检测方法和指标。

方法

横断面研究设计入选2018年1-10月就诊于我科并确诊的原发性醛固酮增多症60例(男性占53.3%，平均年龄50岁)，同时入选基线资料匹配的原发性高血压82例(男性占50.0%，平均年龄50岁)，健康对照者114例(男性占38.6%，平均年龄46岁)。应用化学发光法与放射免疫法分别检测血浆醛固酮浓度和血浆肾素浓度/肾素活性。利用相关性分析评价两种方法的筛查价值，同时通过绘制受试者工作特征曲线(ROC)对两种方法测得的血浆醛固酮浓度、血浆肾素浓度(或活性)、血浆醛固酮/直接肾素浓度比值(ratio of aldosterone/diret rennin concentration

ADRR)、血浆醛固酮/血浆肾素活性比值(ratio of aldosterone/plasma rennin activity

ARR)及两两联合指标进行评价，计算敏感性和特异性，确定最佳切点值。

结果

血浆肾素活性和直接肾素浓度高度相关(

=0.880 4

0.001)，而两种方法测得的血浆醛固酮浓度的相关性欠佳(

=0.365 0

0.001)。各项筛查指标中ADRR的敏感性最高(91.53%)，联合血浆醛固酮浓度(化学发光法)可显著提高诊断的特异性(96.49%)。平均年龄50岁的原发性醛固酮增多症患者中，ADRR筛查切点为12(pg·mL

-1

)/(μU·mL

-1

)，ARR的筛查切点为20 (ng·dL

-1

)/(ng·mL

-1

·h

-1

)。

结论

化学发光法检测原发性醛固酮增多症筛查指标的价值优于放射免疫法，联合血浆醛固酮浓度(化学发光法)和ADRR指标的诊断特异性最佳。

Abstract

Objective

To compare the sensitivity and specificity of chemiluminescence immunoassay (CLIA) and radioimmunoassay (RIA) in detection of aldosterone and renin

and to explore the optional detection methods and indicators for screening primary aldosteronism (PA).

Methods

A cross-sectional study was carried on 60 PA patients (with males accounting for 53.3% and at a median age of 50 years) diagnosed in our department from January to October 2018. Another baseline-matched 82 patients with essential hypertension (with males accounting for 50.0% and at a median age of 50 years) and 114 healthy controls (males accounting for 38.6% and at a median age of 46 years) at the same period were also recruited in this study. The plasma aldosterone concentration and renin concentration/renin activity were measured by CLIA and RIA respectively. The screening value of the 2 methods was evaluated by correlation analysis. Meanwhile

the plasma aldosterone concentration

plasma renin concentration (or activity)

ratio of aldosterone/direct rennin concentration (ADRR)

ratio of aldosterone/plasma rennin activity (ARR) and 2 combined indicators were measured by receiver operating characteristic (ROC) curve

to calculate sensitivity and specificity and determine the optimal cut-off point.

Results

There was a high correlation between plasma renin activity and direct renin concentration (

=0.880 4

0.001)

but the correlation between plasma aldosterone concentration measured by the 2 methods was not good (

=0.365 0

0.001). The sensitivity of ADRR was the highest (91.53%) among all screening indices

and the specificity of diagnosis was significantly improved by combining plasma aldosterone concentration (CLIA

96.49%). Among PA at an average age of 50 years

ADRR screening cut-off point was 12 (pg·mL

-1

)/(μU·mL

-1

)

and ARR screening cut-off point was 20 (ng·dL

-1

)/(ng·mL

-1

·h

-1

Conclusion

CLIA is superior to RIA in detection of screening indices for PA. The diagnostic specificity of combined plasma aldosterone concentration (CLIA) and ADRR indices is the best.

关键词

Keywords

references

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