原发性醛固酮增多症与原发性高血压患者血浆vWF、sICAM-1的变化及诊断学价值

The changes of plasm vWF and sICAM-1 in patients with PA and EH and their diagnostic values

摘要:

目的 探讨原发性醛固酮增多症（PA）与原发性高血压（EH）患者血浆血管性假血友病因子（vWF）、可溶性细胞间黏附分子-1（sICAM-1）的变化及诊断学价值。方法 选取2020年8月—2022年8月青岛大学附属青岛市海慈医院经病理学确诊的PA患者80例作为PA组，选取同期就诊的性别、年龄、血压水平相匹配的80例EH患者作为EH组。比较两组的体质量指数、收缩压、舒张压、空腹血糖、尿酸、肌酐、vWF、sICAM-1、24 h尿蛋白、尿蛋白排泄率（UAER）、左心室质量指数（LVMI）。绘制受试者工作特征（ROC）曲线分析vWF、sICAM-1单独及联合检测PA、EH的诊断效能。结果 PA组vWF、sICAM-1、醛固酮与肾素活性比值（ARR）高于EH组（P <0.05）。两组患者UA、Scr比较，差异均无统计学意义（P >0.05）。PA组24 h尿蛋白、UAER、LVMI高于EH组（P <0.05）。Pearson相关性分析显示，PA组患者vWF水平与ARR、24 h尿蛋白、UAER和LVMI均呈正相关（r =0.617、0.485、0.539和0.476，均P <0.05）。PA组患者sICAM-1与ARR、24 h尿蛋白、UAER、LVMI均呈正相关（（r =0.584、0.511、0.520和0.439，均P <0.05）。ROC曲线分析显示，vWF、sICAM-1联合应用诊断PA、EH的敏感性、特异性和曲线下面积最高，分别为97.28%（95% CI：0.882，0.963）、特异性90.11%（95% CI：0.874，0.931）、曲线下面积为0.957（95% CI：0.748，0.973）。结论 PA患者的血管内皮功能损伤较EH患者更加严重，vWF、sICAM-1在鉴别诊断PA与EH病因中具有一定的价值，且与患者出现肾素-醛固酮系统紊乱、靶器官损害有关。

Abstract:

Objective To investigate the changes of plasma von Willebrand factor (vWF) and soluble intercellular adhesion molecule-1 (sICAM-1) in patients with primary aldosteronism (PA) and essential hypertension (EH) and their diagnostic values.Methods Eighty patients with PA confirmed by pathological examinations in our hospital from August 2020 to August 2022 were selected as PA group, and eighty sex-, age- and blood-pressure-matched EH patients in our hospital during the same period were included as EH group. Body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FPG), uric acid (UA), serum creatinine (Scr), vWF, sICAM-1, 24-hout urine protein, urinary albumin excretion rate (UAER), and left ventricular mass index (LVMI) were measured and compared between the two groups. The diagnostic efficacy of vWF and sICAM-1 alone and their combination for PA and EH was analyzed via receiver operating characteristic (ROC) curves.Results The levels of vWF and sICAM-1 as well as the aldosterone-to-renin ratio (ARR) in PA group were higher than those in EH group (P < 0.05). There was no significant difference in the levels of UA and Scr between PA group and EH group (P > 0.05). The level of 24-hour urine protein, UAER, and LVMI in PA group were higher than those in EH group (P < 0.05). Pearson correlation analysis revealed that the level of vWF was positively correlated with the ARR, the level of 24-hour urinary protein, UAER, and LVMI in PA group (r =0.617, 0.485, 0.539 and 0.476, all P <0.05), and that the level of sICAM-1 was also positively correlated with the ARR, the level of 24-hour urinary protein, UAER, and LVMI in PA group (r =0.584, 0.511, 0.520 and 0.439, all P <0.05). ROC curve analysis demonstrated that the combined detection of vWF and sICAM-1 in diagnosing PA and EH yielded the highest sensitivity, specificity, and the area under the ROC curve, with them being 97.28% (95% CI: 0.882, 0.963), 90.11% (95% CI: 0.874, 0.931) and 0.957 (95% CI: 0.748, 0.973), respectively.Conclusions The impairment of vascular endothelial function in patients with PA is severer than that in patients with EH. In addition, vWF and sICAM-1 are of certain value in differentiating PA from EH, and are partially associated with the disorder of renin-angiotensin-aldosterone system and the dysfunction of target organs in PA and EH patients.