改良岩下窦静脉采血在库欣病诊断中的应用  

The clinical application of adjusted inferior petrosal sinus sampling in Cushing＇s disease

作　　者：周薇薇[1] 苏颈为 姜蕾[1] 蒋怡然[1] 张华[2] 吴志远[2] 武鲁铭 宁光[1] 王卫庆[1] 

机构地区：[1]国家代谢性疾病临床医学研究中心,上海市内分泌代谢病临床医学中心,上海市内分泌肿瘤重点实验室,上海交通大学医学院附属瑞金医院内分泌代谢病科,上海市内分泌代谢病研究所,上海200025 [2]交通大学医学院附属瑞金医院放射科,上海200025

出　　处：《中华内分泌代谢杂志》2016年第3期196-200,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金青年基金（81400779）;中华医学会临床医学科研专项资金项目（13050890474）;上海卫生系统先进适宜技术推广项目（2013SY016）

摘　　要：目的岩下窦静脉采血（inferiorpetrosalsinussampling，IPSS）有助于确认ACTH依赖性库欣综合征患者中ACTH肿瘤的分泌来源，但存在一定的假阴性。本研究拟通过催乳素校正来改良IPSS技术，探讨其在库欣病诊断中的临床意义。方法纳入93例ACTH依赖性库欣综合征患者，包括87例库欣病和6例异位ACTH综合征患者。所有患者均进行了催乳素校正的IPSS检查。结果库欣病患者ACTH岩下窦／外周（inferiorpetrosalsinustoperipheralgradient，IPS／P）比值和催乳素校正IPS／P比值均显著高于异位ACTH综合征患者[11．3（5．0～22．4）对1．4（1．2～2．0），3．3（1．9～4．8）对0．5（0．2～1．0），均P〈0．01]。非改良IPSS的假阴性率为10．3％；经催乳素校正后，IPSS诊断准确性从89．2％提高到96．8％。与其它定位诊断试验比较．催乳素校正IPSS的敏感性和特异性最高。结论IPSS对鉴别ACTH肿瘤来源而言是一种可信度很高的检查，采用催乳素校正能减少IPSS假阴性结果，有效提高诊断准确性。Objective Inferior petrosal sinus sampling （IPSS） is helpful in confirming the source of ACTH secreting tumor in ACTH-dependent Cushing＇s syndrome. However, false-negative results have been reported. Prolactin level adjustment may reduce false-negative results of IPSS. This study was to investigate the utility of prolaetin measurement during IPSS in patients with Cushing＇s disease. Methods This study included 93 patients with a pathological diagnosis of Cushing＇s disease （ n = 87 ） or eetopic Cushing＇s syndrome （ n = 6）. Clinical, biochemical, and radiological records were reviewed and all cases underwent IPSS with prolactin adjustment. Results Baseline and prolaetin adjusted inferior petrosal sinus to peripheral gradient （IPS/P） ratio were significantly higher in patients with Cushing＇s disease than those with ectopic Cushing＇s syndrome [ 11.3 （ 5.0-22.4 ） vs 1.4 （ 1.2-2.0 ） , 3.3 （ 1.9-4.8 ） vs 0.5 （0.2-1.0）, both P〈0.01 ]. False-negative rate of baseline IPSS was 10.3%. Prolactin level adjustment could improve the diagnostic accuracy rate of IPSS from 89.2 % to 96.8 % in Cushing＇ s disease. Compared to other diagnostic procedures, the prolactin adjusted IPSS may achieve highest sensitivity and specificity. Conclusion Prolactin normalization may improve the accuracy of IPSS in predicting pituitary ACTH secreting adenoma and is helpful to adjust negative results of IPSS.

关 键 词：库欣病 岩下窦静脉采血 催乳素 

分 类 号：R586[医药卫生—内分泌]