摘要目的:探讨24 h尿醛固酮（UEA）在原发性醛固酮增多症（PA）诊断及分型诊断中的临床应用价值。方法:回顾性纳入2020年12月到2023年12月在中南大学湘雅三医院内分泌科住院的282例高血压患者，排除肾实质性高血压、肾血管性高血压、皮质醇增多症、嗜铬细胞瘤副神经节瘤、甲状腺及甲状旁腺疾病、主动脉疾病等继发性高血压患者39例。最终纳入243例，男130例，女113例，年龄［ M（ Q1， Q3）］50.0（41.0，56.5）岁，根据高血压病因分为PA组（ n=135）和原发性高血压组（ n=108）。测定立位2 h血浆醛固酮浓度（PAC）及肾素活性（PRA），留取24 h尿液采用液相色谱串联质谱法检测UEA。通过受试者工作特征（ROC）曲线下面积评估24 h UEA及24 h UEA与肾素活性比值（UARR）在PA筛查诊断中的价值。收集基于肾上腺静脉采样和（或）手术病理及术后随访结果明确PA亚型的97例患者进行亚组分析，分为单侧原发性醛固酮增多症（UPA）（ n=54）和特发性醛固酮增多症（IHA）（ n=43）组，通过绘制ROC曲线评估血钾、立位PAC、醛固酮与肾素比值（ARR）、24 h UEA及UARR在PA分型诊断中的价值。 结果:PA组血钾及PRA均低于原发性高血压组（均 P<0.01），而PA组收缩压、舒张压、血钠、尿钾、PAC、ARR、UEA及UARR均高于原发性高血压患者（均 P<0.05）。24 h UEA诊断PA的ROC曲线下面积为0.848（95% CI：0.799~0.897），cut-off值为8.42 μg/d，灵敏度和特异度分别为99.3%和59.3%。低于ARR的ROC曲线下面积为0.986（95% CI：0.977~0.996），灵敏度和特异度分别为100.0%和88.0%。UARR的ROC曲线下面积为0.988（95% CI：0.980~0.997），cut-off值为20.3（μg/d）/（ng·ml -1·h -1），灵敏度和特异度分别为90.4%和83.2%，与ARR差异无统计学意义（ P>0.05）。亚组分析显示：24 h UEA及UARR鉴别诊断UPA及IHA的ROC曲线下面积分别为0.772（95% CI：0.679~0.865）及0.664（95% CI：0.539~0.764），24 h UEA>16.8 μg/d及UARR>135.0（μg/d）/（ng·ml -1·h -1）预测UPA的灵敏度分别为59.3%及61.1%，特异度分别为86.0%及74.4%。 结论:24 h UEA可为临床筛查诊断PA提供参考，若联合肾素检测可提供与ARR相当的筛查诊断价值。另外，24 h UEA、UARR可作为PA分型诊断的较好预测指标。

abstractsObjective:To investigate the clinical application value of 24-hour urinary aldosterone(UEA) in diagnosis and classification of primary aldosteronism(PA).Methods:A retrospective analysis was conducted on 282 hypertensive patients admitted to the Endocrinology Department of Xiangya Third Hospital of Central South University from December 2020 to December 2023. Thirty-nine patients with secondary hypertension, included secondary hypertension caused by renal parenchymal hypertension, renal vascular hypertension, cortisol hypersecretion, pheochromocytoma and paraganglioma, thyroid and parathyroid diseases and aortic diseases, were excluded. A total of 243 patients were finally included, including 130 males and 113 females, with the age of [ M( Q1, Q3)]50.0(41.0, 56.5) years. The patients were divided into PA group ( n=135) and primary hypertension group ( n=108) based on the cause of hypertension. Plasma aldosterone concentration (PAC) and renin activity (PRA) were measured at 2 hour of standing position. Twenty-four-hour urine samples were collected for determination of aldosterone by liquid chromatography tandem mass spectrometry. The area under receiver operating characteristic (ROC) curve was drawn to evaluate the value of 24-hour UEA and 24-hour UEA to renin ratio (UARR) in the screening of PA. Ninety-seven patients with PA subtypes identified based on adrenal vein sampling (AVS) and/or surgical pathology and postoperative follow-up results were enrolled. They were divided into unilateral primary hyperaldosteronism (UPA) group ( n=54) and idiopathic hyper aldosteronism(IHA) group ( n=43). ROC was drawn to evaluate the value of serum potassium, standing PAC, aldosterone to renin ratio (ARR), 24-hour UEA and UARR in the diagnosis of PA typing. Results:Serum potassium and PRA in PA group were lower than those in primary hypertension group (all P<0.01), while systolic blood pressure, diastolic blood pressure, blood sodium, urine potassium, PAC, ARR, UEA and UARR in PA group were higher than those in primary hypertension group (all P<0.05). The area under ROC curve for 24-hour UEA diagnosis of PA was 0.848(95% CI:0.799-0.897), the cut-off value was 8.42 μg/d, sensitivity and specificity were 99.3% and 59.3%, respectively. The area under the ROC curve was 0.986(95% CI:0.977-0.996), with sensitivity and specificity of 100.0% and 88.0%, respectively. The area under the ROC curve of UARR was 0.988(95% CI: 0.980-0.997), the cut-off value was 20.3 (μg/d)/(ng·ml -1·h -1), sensitivity and specificity were 90.4% and 83.2%, respectively. There was no significant difference between UARR and ARR ( P>0.05). Subgroup analysis shows that the areas under the ROC curves for the diagnosis of 24-hour UEA and UARR in differentiating UPA from IHA are 0.772(95% CI:0.679-0.865) and 0.664(95% CI:0.539-0.764), respectively. The sensitivity of 24-hour UEA>16.8 μg/d and UARR>135.0 (μg/d)/(ng·ml -1·h -1) to predict UPA was 59.3% and 61.1%, respectively, and the specificity was 86.0% and 74.4%, respectively. Conclusions:Twenty-four-hour UEA can provide reference for clinical screening and diagnosis of PA. If combined with renin activity detection, it can provide screening value comparable to ARR. In addition, 24-hour UEA and UARR can be used as better predictors of PA typing diagnosis.