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目的了解尿醛固酮浓度（UAC）对于原发性醛固酮增多症（原醛）的诊断价值；对比研究液相色谱串联质谱法（LC-MS/MS）和化学发光法（CLIA）检测UAC结果的一致性并建立各自的诊断切点。方法纳入2018年10月至2019年8月就诊的高血压查因患者133例，其中原醛患者55例（醛固酮瘤30例，特发性醛固酮增生25例），原发性高血压（EH）患者78例。采用CLIA法及LC-MS/MS法平行检测UAC并比较两种方法的相关性、一致性。构建UAC、尿醛固酮/肾素活性比值（UARR）诊断原醛的受试者工作特征（ROC）曲线。以尿钠≥130 mmol/24 h为界建立相对高尿钠组（n=51），比较不同钠盐摄入情况对于诊断价值的影响。结果①CLIA法与LC-MS/MS法检测的UAC结果呈正相关（r=0.69，P＜0.01），Bland-Altman法分析提示两种方法所测UAC一致性欠佳。②UACCLIA及UACLC-MS/MS诊断原醛的价值均不及ARR。而UACCLIA及UACLC-MS/MS的诊断价值无统计学差异。UACCLIA的ROC曲线下面积（AUC）为0.739,切点为5.1 μg/24 h。UACLC-MS/MS的AUC为0.659，切点为11.6 μg/24 h。ARR的AUC为0.943，最佳切点为23.2 ng·dL-1/（μg·L-1·h-1）。③UARR对于原醛的诊断价值较高，与ARR相当。UARRCLIA的AUC为0.924，诊断切点为1.75 μg·24 h-1/（μg·L-1·h-1）。UARRLC-MS/MS的AUC为0.906，诊断切点为4.63 μg·24 h-1/（μg·L-1·h-1）。④相对高尿钠亚组UACLC-MS/MS的AUC为0.708，切点为14.9 μg/24 h。诊断价值较分组前并不能进一步提高。结论单一指标UAC诊断原醛的价值较低，但UARR诊断原醛的诊断价值显著提高，与ARR相当。UACLC-MS/MS、UACCLIA诊断切点分别为11.6 μg/24 h、5.1 μg/24 h，UARRLC-MS/MS、UARRCLIA的诊断切点分别为4.63 μg·24h-1/（μg·L-1·h-1）、1.75 μg·24 h-1/（μg·L-1·h-1）。另LC-MS/MS法与CLIA法检测UAC一致性欠佳，提示临床上使用不同检测方法需要采用不同参考值范围。

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Objective To investigate the effect of acoustic radiation pulse imaging(ARFI)on the quantitative determination of renal parenchyma hardness in patients with nutcracker syndrome(NS). Methods 54 cases of NS patients in the hospital were selected as the NS group, and 40 healthy young people were selected as the control group. The diameter of the left renal vein across the abdominal aortic stenosis(a)and the proximal renal segment(b)and its peak flow velocity(Va, Vb)were measured using conventional ultrasound. SWV values were obtained by measuring the bilateral renal parenchyma hardness using ARFI. The difference between the measured values of the two groups of patients was analyzed by t test. Spearman correlation was used to analyze the correlation between SWV measurements of renal parenchyma and patients′age, body mass index(BMI)and serum creatinine. Results The inner diameter(a)of the LRV stenosis group in the NS group was significantly smaller than that in the control group(supine position, posterior extension position), b/a(supine position, posterior extension position)was significantly greater than the control group, and the difference was statistically significant(P <0.05). There were statistically significant differences between the two groups in the supine position Va(supine position, posterior extension position)and Va/Vb(supine position, posterior extension position)(P<0.05). The SWV value of the left kidney in the NS group was significantly lower than that in the right kidney, and the difference was statistically significant(P<0.05). There was no significant correlation between SWV value of left kidney and GFR, creatinine(Cr), venous diameter ratio, and venous blood flow ratio in NS group(P>0.05). The SWV value of left kidney in NS group was positively correlated with BMI(P<0.05), and b/a(supine position, posterior extension position), blood flow velocity ratio Va/Vb(supine position, posterior extension position), left kidney segment The arterial resistance index was negatively correlated(P<0.05). Conclusion ARFI is a new method for assessing renal parenchymal changes in NS patients. A significant increase in SWV and a significant increase in the peak flow velocity at the left renal vein stenosis can be used as a reference for the diagnosis of NS positivity. [ABSTRACT FROM AUTHOR]

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