午夜1 mg地塞米松抑制试验对肾上腺意外瘤中亚临床库欣综合征的诊断价值  

Evaluation of the 1 mg overnight dexamethasone suppression test in the diagnosis of the subclinical Cushing＇s syndrome in patients with Adrenal Incidentaloma

作　　者：李乐乐[1] 韩白玉 窦京涛[1] 杨国庆[1] 谷伟军[1] 吕朝晖[1] 母义明[1] 

机构地区：[1]解放军总医院内分泌科全军内分泌代谢重点实验室,北京100853 [2]解放军第二六四医院内分泌科

出　　处：《中华医学杂志》2015年第48期3912-3916,共5页National Medical Journal of China

摘　　要：目的 探讨午夜1mg地塞米松抑制试验（1 mg-DST）对肾上腺意外瘤中亚临床库欣综合征（SCS）的诊断价值和最佳诊断切点.方法 收集1995-2013年解放军总医院内分泌科收治并行内分泌功能评估的肾上腺意外瘤患者的临床资料,根据小剂量地塞米松抑制试验（LDDST）结果分为两组：SCS组（49例）和肾上腺无功能皮质腺瘤（NFA）组（447例）,分析比较两组患者一般特征、内分泌功能评估结果,并应用ROC曲线评价午夜1 mg-DST对肾上腺意外瘤中SCS的诊断价值,得出灵敏度与特异度均较高的最佳诊断切点.结果 NFA组447例,男224例,女223例,就诊年龄（53±11）岁;SCS组49例,男19例,女30例,就诊年龄（47±12）岁.以抑制后血清皮质醇绝对值的曲线下面积AUC最大（0.967,95％CI：0.942～0.993）.以抑制后血清皮质醇水平63.65 nmol/L为诊断切点,1 mg-DST诊断SCS的准确性最好,试验的灵敏度与特异度之和最大,灵敏度100.0％,特异度88.8％.血清皮质醇抑制率最佳切点是85.64％,灵敏度83.3％,特异度84.6％.结论 1 mg-DST诊断SCS以抑制后血清皮质醇63.65 nmol/L为切点试验的灵敏度与特异度之和最大,推荐为最佳诊断切点.血清皮质醇抑制率亦是诊断亚临床库欣综合征的较好指标.Objective To evaluate efficacy of the 1 mg overnight dexamethasone suppression test （1 mg overnight DST） in the diagnosis of subclinical Cushing＇s syndrome,and to explore the best diagnostic cut-off value.Methods The clinical data of patients with adrenal incidentaloma in Chinese PLA General Hospital from 1995 to 2013 were gathered.The data of subclinical Cushing＇s syndrome （SCS） and nonfunctional adrenal adenoma （NFA） was retrospectively analyzed.The ROC curve was used to evaluate the efficacy of the 1 mg overnight DST and to explore the best cut-off value with high sensitivity and specificity.Results There were 447 patients with NFA （224 male and 223 female）,and the mean age was 53 ± 11 years old.49 patients were with SCS （19 male and 30 female）,and the mean age was 47 ± 12 years old.The area under the ROC of serum cortisol level after 1 mg overnight DST was 0.967 （95%CI：0.942-0.993）.The best cut-off value of serum cortisol after 1 mg overnight DST was 63.65 nmol/L,with a sensitivity of 100.0% and a specificity of 88.8%.The best cut-off value of the suppression ratio of serum cortisol was 85.64%,with a sensitivity of 83.3% and a specificity of 84.6%.Conclusions The best criterion for 1 mg ovemight DST in the diagnosis of SCS was serum cortisol level,and the recommend cut-off point was 63.65 nmol/L,with both a higher sensitivity and specificity.The suppression ratio of serum cortisol after 1 mg overnight DST was also considered as a suitable criterion in the diagnosis of SCS.

关 键 词：亚临床库欣综合征 地塞米松抑制试验 灵敏度 特异度 

分 类 号：R736.6[医药卫生—肿瘤]