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优化阿尔多斯特与雷宁比率的切断值,以根据心血管风险查原发性阿尔多斯特症:一项合作研究
Chunxue He1, Ruolin Li2, Jun Yang3,4
1Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Clinical and experimental hypertension (New York, N.Y. : 1993)
|January 25, 2024
概括
优化阿尔多斯特与因比率 (ARR) 切断点对于初级阿尔多斯特症 (PA) 查至关重要. 较低的ARR值为1.0 ng·dl-1/mIU·l-1更好地识别高心血管疾病 (CVD) 风险的患者.
科学领域:
- 内分泌学 在内分泌学.
- 心血管医学 心血管医学
- 高血压研究 高血压研究
背景情况:
- 查原发性阿尔多斯特 (PA) 通常使用阿尔多斯特与雷宁比率 (ARR).
- 目前的ARR切断指南差异很大 (1.3-4.9 ng·dl-1/mIU·l-1),可能会影响诊断准确度.
- 优化ARR切线对于准确的PA诊断和心血管疾病 (CVD) 风险分层至关重要.
研究的目的:
- 为了确定与心血管疾病 (CVD) 风险相关的PA查的最佳ARR切断值.
- 评估当前指南推的ARR切断值在识别心血管疾病风险较高的PA患者中的有效性.
主要方法:
- 从Framingham后代研究 (FOS) 中对高血压参与者的纵向分析 (n=1,433) 以确定心血管疾病风险值.
- 使用Spline回归计算基于CVD事件的ARR值.
- 使用重庆初级阿尔多斯特学研究 (CONPASS) 进行横截面验证,以评估已识别的ARR截止值的适用性.
主要成果:
- 在FOS中,心血管疾病风险增加,ARR高达1.0 ng·dl-1/mIU·l-1,之后趋于平稳.
- 在CONPASS中,ARR≥1.0的PA患者与基本高血压 (OR2.24) 相比,表现出更高的心血管疾病风险.
- 目前的ARR切割值 (2.4-4.9 ng·dl-1/mIU·l-1) 可能会错过10-30%的PA患者,他们的心血管疾病风险明显更高.
结论:
- 基于心血管疾病风险,PA查的最佳ARR切线值为1.0 ng·dl-1/mIU·l-1.
- 现有的指导方针推的ARR切线可能导致高心血管疾病风险患者的PA诊断不足.
- 实施较低的ARR截止值可以改善PA的识别和随后的心血管风险管理.
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