.论原发性醛固酮增多症患者血清NT-proBNP改变及临床意义研究娄宏哲(沈阳市第十人民医院检验科110044)摘要：目的探讨原发性醒因剖增多症(PA)患者血清脑利钠肽前体N末端(、T-proBNP)改变及格床意义。方法的入2012年1月至2015年12月疑似PA的高血压患寿140例，分为PA组(n-30)和原发性高血压(EH)组3=110).检测两鲍息者血清NT-proBNP和骨素水平，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水平月PA的相关性。结果PA组息者血清NT-proBNP水平[(93.9x7.3)pg/mLj明里高于EH组患者[(69.5士10.4)pg/mL],lt异有晚计学意义(P<0.05).单倒亚组PA息者肾素[(6.8±1.3)pg/mLw.(5.1士0.6)pg/mL]、血浆眺固时/血浆肾素比值(ARR)[(65.5±16.4)w.(57.1±14.4)]和NT-proBNPL(101.9±14.1)pg/mLw.(90.4±8.Dpg/mL]水平明显高于双倒亚短，差异均有就计学意义(PV0.05).NT-proBNP预测PA的AUC为0.809,95%CI：0.734-0.865,cut-off为98.4pg/mL,M感度为83.4%,特异度为78.6%.预测单侧PA的AUC为0.733,95%CL0.648〜0.804,cut-off为109.6pg/mL,敏感废为79.9%,#异度为81.5%.血清NT-proBNP水平月ARR(r=0.765,P<0.05),PA(r=0.728,P<0.05)和单侧PA(r=0.778,P<0.05)X正相关。结怆PA息者相比EH患者血清NT-proBNP水平桎度升高，有助于PA患者的平期诊断和筛查.关It词：原发性醒固酮增多症$脑利钠肽前体N末端,受试者工作特征曲钱u肾素DOI：10.3969/j.issn.1672-9455.2016.22.020文献标志码：A文章编号：1672-9455(2016)22-3183-03TheclinicalvalueofchangesofserumNT-proBNPinpatientswithprimaryaldosteronismLOUHongzhe(.DepartmentofClinicalLaboratory,theTenthPeople'sHospitalofShenyang,ShenyangLiaoning110044,Cirnz)Abstract:ObjectiveToevaluatetheclinicalvalueofchangesofserumNT-proBNPinpatientswithprimaryaldosteronism(PA).MethodsOne-hundredsandfortypatientswithPAwereenrolledinthisstudyanddividedintotwogroup：PAgroup(〃=30)andessentialhypertension(EH)group(”=110).ThelevelofNT-proBNPandreninweredetected.TheROCanalysisandcor-relationanalysiswereusedtoestimatetheassociationbetweenserumNT-proBNPandPA.ResultsThelevelsofNT-proBNPinPAgroup[(93.9±7.3)pg/mL]weresignificantlyhigherthanthoseinEHgroupC(69.5±10.4)pg/mL](P<0.05).Thelevelsofrenin[(6.8±1.3)pg/mLvs.(5.l±0.6)pg/mL],plasmaaldosterone-to-reninratio(ARR)[(65.5±16.4)vs.(57.1土14.4)]andNT-proBNP[(101.9±14.1)pg/mLvs.(90.4±8.1)pg/mL]inunilateralsubgroupwereallsignificantlyhigherthanthoseinbilateralsubgroup(P<0.05).TheAUCofNT-proBNPfordiagnosisofPAwas0.809,95%CI：0.734—0.865,thecut-offvaluewas98.4pg/mL,andthespecificityandsensitivitywere78.6%and83.4%respectively.TheAUCofNT-proBNPfordiagnosisofunilateralPAwas0.733«andcut-offvaluewas109.6pg/mL,95%CI：O.648—0,804,andspecificityandsensitivitywere81.5%and79.9%respectively.Inaddition♦NT-proBNPwaspositivelycorrelatedwithARR(r=0.765,PV0.05)»PA(r=0.728.P<0.05)andunilateralPA(r=0.778,PV0.05).ConclusionIncomparisonwithEHpatients*thelevelsofserumNT-proBNPareslightlyincreased.whichmaybehelpfulforPAearlydiagnosis.Keywords；primaryaldosteronismiNT-proBNPjROCcurvejrenin原发性醛固酮增多症（PA）是由于肾上腺皮质发生病变，合成释放出过多的醛固酮，导致体内水钠潴留、血容量增多，进而抑制体内肾素-血管紧张素系统，临床特点主要是高血压和低血钾⑴.李南方等⑵回顾性分析213例PA患者临床资料，结果发现PA患者左室肥厚的发生率明显高于原发性高血压患者，其左室构型以离心性肥厚最多见.PA患者体内高浓度的醛固酮具有慢性的心肌毒性，这主要是由于醛固酮特异性结合并激活盐皮质激素受体，持续性的引起神经体液通路兴奋，促使心肌结构改变，表现为左心室负荷增加，左室质量指数升高⑴。因此，临床上心功能衰竭患者长期服用醛固酮受体拮抗剂有助于抑制心室重构，改善长期预后。...