中文摘要：

【目的】为规范从高血压患者中筛查原发性醛固酮增多症（PA）的流程，提高临床对PA的认识和诊断率。【方法】回顾性分析2011年12月至2012年12月在本院内分泌科就诊的高血压患者204例临床资料。①比较原发性高血压（PHT）患者和PA患者血浆醛固酮水平（PAC）和血浆肾素活性（PRA）与PAC／PRA比值（ARR）的差异；②统计PA患者中高血压不同级别所占的比例及其各自的ARR特点；③计算不同ARR值诊断PA的敏感性和特异性；④比较PHT与PA患者靶器官损害程度；⑤分析PA病程与靶器官损害的关系；⑥比较PA患者手术治疗后血钾、血压恢复情况及其与术前患者病程长短的关系。【结果】①通过ARR初筛以及进一步的立卧位试验结合CT及临床表现共诊断PA46例，占同期筛选高血压患者的22．5％。其中高血压1级3例（6．5％）、高血压2级12例（28．3％）、高血压3级30例（65．2%），1例血压正常，以低钾CT异常并ARR异常支持诊断。平均收缩压（178±26．4）mmHg，平均舒张压（111±19．6）mmHg。②若以20为截点并联合PAC〉15ng／dL时诊断敏感性为85．7％，特异性为84．4％。③PA组并发症明显高于PHT组，其差异有统计学差异（P〈0．05）。④PA组服用降压药物种类明显多于PHT组，且降压有效率明显低于PHT组。【结论】①PA在高血压2级及以上的患病率更高，在本组高达20％。②ARR对筛查PA有一定意义，以ARR为20截点并联合血PAC〉15ng／dL，有较高的敏感性及特异性。③PA患者高血压对ii靶器官的损害远较PHT患者严重，并与其病程有关。④PA患者手术为较好的治疗方法，术后血压较术前较易控制，低钾一般可得到纠正，但术前病史长，血压偏高的患者手术后效果明显下降，故提倡早发现、早诊断、早治疗。

英文摘要：

[ObjectivelTo standardize the screening process of patients with primary aldosteronism （PA） to improve the understanding of PA and the diagnostic accuracy of PA. [Methods]The 204 cases of hypertension patient in our hospital between December 2011 and December 2012 were analyzed retrospectively. We calculated the constituent ratio of PA in all 204 hypertension cases, analyzed the clinical characteristics of these cases including clinical symptoms, laboratory examinations, image examinations, and treatments. Next, we analyzed the difference between the PA patients and the hypertension patients. Afterwards, we calculated the plasm aldosterone to rennin ratio （ARR） and analyzed the specificity sensitivity of different values of ARR and compared the difference of target organ damage between the PA patients and the hypertension patients. Finally, we analyzed the relationship between the length of PA patients and the target organ damage as well as the causes that influence the status of hypertension after the surgery. [Results]We diagnosed 46 PA patients from hypertension patients by screening of ARR, clinical characteristics, and CT the incidence of PA patients in hypertension was 22.5%. The mean age （45.7± 8.9） years; there were male 21 cases and female 25 cases; stage 1 had 3 cases （6.5%）, stage 2 had 13 cases （28.3%）, stage 3 had 30 cases （65.2%）; one of PA patient blood pressure was normal. The average systolic pressure was（178 ±26.4） mmHg and the average diastolic pressure （111 ± 19.6） was mmHg. We used ARR 20 as the diagnostic cut-off with PAC〉15ng/dl, the sensitivity of diagnosis was 85.7%, and the specificity was 84.4 %. The PA patients group had more complications than the hypertension patients group. The PA patients group used more antihypertensive drugs than hypertension patients group. [Conclusion]The incidence of patients with PA was extremely high in stage 2 hypertension, in our study the incidence had reached 20~. ARR have diagnostic value, and with the use of ARR 20