双侧岩下窦静脉取血联合去氨加压素刺激试验诊断库欣病的价值  

Evaluation of desmopressin stimulated bilateral inferior petrosal sinus sampling in diagnosing Cushing＇ s disease

作　　者：杨叶虹[1] 张晓龙[2] 周丽诺[1] 金艺璇 李士其[3] 鹿斌[1] 叶红英[1] 闻杰[1] 赵晓龙[1] 胡仁明[1] 

机构地区：[1]复旦大学附属华山医院内分泌科,上海200040 [2]复旦大学附属华山医院放射科,上海200040 [3]复旦大学附属华山医院神经外科,上海200040 [4]常熟新区医院内分泌科

出　　处：《中华内分泌代谢杂志》2011年第11期880-882,共3页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨双侧岩下窦静脉取血（BIPSS）过程中联合去氨加压素（DDAVP）刺激试验在库欣病诊断中的意义。方法16例垂体MRI未见明确肿瘤的ACTH依赖性库欣综合征患者行大剂量地塞米松抑制试验、BIPSS联合DDAVP刺激试验等检查。DDAVP刺激前及刺激后5min、10min测定岩下窦静脉与外周静脉血ACTH的比值。比值〉2者考虑库欣病。比较DDAVP刺激的BIPSS及大剂量地塞米松抑制试验和术后诊断的一致性。结果16例库欣病患者中9例（56．3％）大剂量地塞米松试验可抑制，BIPSS联合DDAVP试验中DDAVP刺激前12例（75．0％）岩下窦静脉与外周静脉血ACTH的比值〉2；刺激后14例（87．5％）患者比值〉2。介入手术过程中未出现明显严重不良反应。结论BIPSS联合DDAVP刺激试验可用于指导影像学检查无明确结果的库欣病患者的鉴别诊断和治疗。Objective To evaluate desmopressin stimulated inferior petrosal sinus sampling in diagnosing Cushing＇s disease. Methods Sixteen ACTH-dependent Cushing＇s disease patients underwent bilateral desmopressin stimulated inferior petrosal sinus （ IPS ） sampling because of negative or equivocal magnetic resonance imaging. Cortisol response to high-dose dexamethasone suppression test was also evaluated. ACTH sampling was taken from a peripheral vein and bilateral IPS before and both 5 and 10 min after injection of desmopressin. Diagnosis was based on the ratio of ACTH level in between IPS to peripheral vein by desmopressin test. Diagnosis was confirmed after surgery. Results High-dose dexamethasone suppression test showed suppressible in 9 of 16 patients with Cushing＇s disease. An IPS gradient 〉2 was found in 14 of the 16 cases （ 87.5% ） with Cushing＇ s disease after desmopressin injection,while before injection the respective figure was 12 of 16（75.0% ）. No severe adverse effects were observed during or after the procedure. Conclusion Desmopressin test during bilateral IPS sampling is a safe and effective diagnostic procedure in Cushing＇s disease.

关 键 词：库欣病 双侧岩下窦静脉取血 去氨加压素 诊断 

分 类 号：R586.2[医药卫生—内分泌]