不同亚型库欣综合征患者肾素-血管紧张素-醛固酮系统变化  

The changes in renin-angiotensin-aldosterone-system in different subtypes of Cushing＆#39;s syndrome

作　　者：崔佳[1] 窦京涛[1] 杨国庆[1] 臧丽[1] 金楠[1] 陈康[1] 杜锦[1] 谷伟军[1] 王先令[1] 杨丽娟[1] 吕朝晖[1] 巴建明[1] 母义明[1] 陆菊明[1] 李江源[1] 潘长玉[1] 

机构地区：[1]解放军总医院内分泌科,北京100853

出　　处：《中华内科杂志》2015年第7期618-622,共5页Chinese Journal of Internal Medicine

摘　　要：目的 分析不同亚型库欣综合征患者肾素-血管紧张素-醛固酮系统（RAAS）的变化及反应差异.方法 回顾性分析2002年9月至2014年5月在解放军总医院内分泌科收治的150例行体位试验检查的库欣综合征患者的临床资料,包括非促肾上腺皮质激素（ACTH）依赖性库欣综合征128例,ACTH依赖性库欣综合征22例.对各组体位试验前后的血浆肾素活性（PRA）、血管紧张素Ⅱ、血浆醛固酮浓度（PAC）、PAC升高比例、立位4h的PAC/PRA （ARR）比例进行比较分析.结果 （1）库欣综合征患者卧位PRA 0.5（0.2,1.3）μg·L-1 ·h-1、PAC（285.0±128.1）pmol/L处于正常范围,血管紧张素Ⅱ（48.9 ±20.1）ng/L在正常偏高水平,经过体位改变的刺激后,PRA 2.4（0.9,5.7）μg·L-1·h-1、PAC（470.1±193.9） pmol/L升高较明显,立位ARR接近正常人上限.（2）根据病因分类,非ACTH依赖性库欣综合征组卧位PAC低于ACTH依赖性库欣综合征组[（274.2±125.0）pmol/L比（348.0±130.4） pmol/L,P＜0.05],而PAC升高比例高于ACTH依赖性库欣综合征组[（81.2±69.3）％比（49.7±26.4）％,P＜0.05],其余指标两组差异无统计学意义.（3）多重线性回归分析显示,卧位PAC与卧位PRA及ACTH水平呈正相关,PAC升高比例与卧位ACTH水平呈负相关.结论 库欣综合征患者体位试验反应与正常人类似,RAAS并未受到明显的激活或抑制,而ACTH对PAC及反应性具有重要影响,但其具体机制有待进一步研究.Objective Cushing＇s syndrome is a clinical condition resulting from chronic exposure to excess glucocorticoid.As a consequence,long-term hypercortisolism contributes significantly to the development of systemic disorders by direct and/or indirect effects.The present study was to analyze the changes of renin-angiotensin-aldosterone-system in different subtypes of Cushing＇s syndrome on the standard posture test.Methods We retrospectively reviewed 150 patients with histologically confirmed Cushing＇s syndrome treated at the PLA General Hospital between 2002 and 2014.Among them,128 patients were diagnosed as adreno-cortico-tropic-hormone （ACTH）-independent Cushing＇s syndrome,and 22 were ACTH-dependent Cushing＇s syndrome.All patients were undertaken the posture test.Plasma renin activity （PRA）,angiotensin Ⅱ,plasma aldosterone concertration （PAC） levels were measured before and after the test.Results Basal plasma PRA [0.5 （0.2,1.3） μg · L-1 · h-1],angiotensin Ⅱ [（48.9 ± 20.1） ng/L] and PAC [（285.0 ± 128.1） pmol/L] levels were within the normal range in supine position.Compared with the subjects with ACTH-independent Cushing＇s syndrome,the basal PAC levels were higher in subjects with ACTH-dependent Cushing＇ s syndrome [（348.0 ± 130.4） pmol/L vs （274.2 ± 125.0） pmol/L,P 〈 0.05].However,the PAC response in subjects with ACTH-dependent Cushing＇s syndrome [（49.7 ± 26.4）%] was significantly lower than that in those with ACTH-independent Cushing＇s syndrome [（81.2 ± 69.3） %] upon upright posture stimulation （P 〈 0.05）.There were no statistical significances in PRA and angiotensin Ⅱ levels between the two groups.The basal PAC and PRA levels were positively correlated with ACTH,whereas PAC response was negatively correlated with ACTH.Conclusions The renin-angiotensin-aldosterone-system activity in subjects with Cushing＇s syndrome was similar to that in normal control.The basal PAC level and its response to upright posture are differently associate

关 键 词：库欣综合征 肾素-血管紧张素系统 体位试验 

分 类 号：R586.2[医药卫生—内分泌]