【摘要】 目的 评估比较单侧原发性醛固酮增多症(原醛症)预测模型在中国人群中的应用价值。方法 纳入确诊原醛症并行肾上腺静脉采血的患者214例。根据采血结果进行分型，单侧原醛症129例，双侧原醛症85例。应用受试者工作特征曲线，灵敏度和特异度分析评价2016年美国内分泌协会原醛症指南推荐标准和已报道的6个预测模型(Kupers评分模型、Nanba评分模型、CONPASS模型、SPACE评分模型、Puar模型和Ma模型)对中国单侧原醛症患者的诊断价值。结果 只有3例患者符合2016年美国原醛指南标准，可不经过肾上腺静脉采血直接诊断为单侧原醛症，特异度为100%,灵敏度仅为2.33%。其余模型受试者工作特征曲线的曲线下面积均<0.7,按照模型作者推荐切点灵敏度16.28%～71.26%,特异度37.74%～86.30%。通过卡托普利抑制实验确诊原醛症的SPACE模型评分总分≥19分时，单侧原醛症特异度为98.63%,灵敏度为9.17%。结论 基于安全性考虑，仅符合2016年美国原醛症指南推荐要求的患者和少部分通过卡托普利抑制实验确诊的SPACE评分总分≥19分的患者能够绕过肾上腺静脉采血直接手术，大部分患者仍需进行采血指导下一步治疗方案。更多还原

【Abstract】 Objective To evaluate and compare the application value of predictive models of unilateral primary aldosteronism(PA) in Chinese population.Methods Two hundred fourteen patients diagnosed with PA and completed adrenal venous sampling(AVS) were included. The patients were subtyped based on blood collection results. There were 129 patients with unilateral PA and 85 with bilateral PA. Based on the subtype, the diagnostic value of the 2016 Endocrine Association Guidelines for PA and 6 IHA prediction models(Kupers score model, Nanba score model, CONPASS model, SPACE score model, Puar model and Ma model) was evaluated using receiver operating characteristic(ROC) curve and sensitivity and specificity analysis.Results Only 3 patients met the 2016 American Primary Aldosteronism Guideline criteria and could be directly diagnosed as unilateral PA without AVS. Its specificity was 100%, and the sensitivity was only 2.33%. The areas under the ROC curves(AUC) of the other models were less than 0.7. The sensitivity was between 16.28% and 71.26%, and the specificity was between 37.74% and 86.30% according to the cut-off point recommended by the authors. The total score of SPACE model confirmed by captopril inhibition test was ≥19, the specificity of unilateral PA was 98.63% and the sensitivity was 9.17%.Conclusions For safety, only patients who met 2016 American guideline criteria for PA and those with a total SPACE score ≥19 confirmed by captopril challenge test would bypass AVS and proceed to surgery. Most patients still need AVS to guide the next treatment plan.更多还原