地塞米松抑制试验中血、尿皮质醇对库欣综合征的诊断价值  

Comparison of efficacy between the serum cortisol and 24 hour urine free cortisol in combined dexamethasone suppression test in the diagnosis of Cushing syndrome

作　　者：卢琳[1] 陈佳蕙 朱惠娟[1] 宋爱羚[2] 李明[2] 陈适[1] 潘慧[1] 龚凤英[1] 王任直[3] 幸兵[3] 姚勇[3] 冯铭[3] 陆召麟[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院内分泌科,国家卫生和计划生育委员会内分泌重点实验室,100730 [2]中国医学科学院,北京协和医学院,北京协和医院检验科,100730 [3]中国医学科学院,北京协和医学院,北京协和医院内神经外科,100730

出　　处：《中华医学杂志》2016年第27期2150-2154,共5页National Medical Journal of China

基　　金：中华医学会临床医学科研专项（13050940479）;国家临床重点专科基金（WBYZ2011-873）

摘　　要：目的评价地塞米松抑制试验（DST）中24h尿游离皮质醇（24hUFC）和血皮质醇对库欣综合征（cs）的诊断价值。方法对北京协和医院2011年1月至2015年11月67例cs患者进行联合DST，比较同步血皮质醇和24hUFC在诊断中的差别。结果小剂量DST中血皮质醇〈50nmol／L诊 断灵敏度最高，为97．01％（P〈0．05）；24hUFC〈32nmol，血皮质醇〈110nmol／L、140nmol／L和对照值50％的诊断灵敏度分别为92．54％，86．57％，83．58％和70．15％。大剂量DST中如切点为抑制率≥50％，24hUFC诊断库欣病的灵敏度和特异度为90．57％和96．00％，均高于血皮质醇的60．38％和91．43％（均P〈0．05）。受试者工作特征曲线分析结果显示，24hUFC抑制率为60．85％时，达到灵敏度（92．6％）、特异度（85．7％）最佳界值；而血皮质醇抑制率为61．53％时也能达到最佳灵敏度（64．8％）和特异度（78．6％）。结论在小剂量DST中血皮质醇〈50nmol／L诊断灵敏度最高；而在大剂量DST中24hUFC的诊断灵敏度和特异度高于血皮质醇。Objective To compare the sensitivity and specificity between the 24 hour urine free cortisol （24 h UFC ） and serum cortisol in dexamethasone suppression test （DST） in the diagnosis of Cushing syndrome （CS）. Methods Combined low dose DST （LDDST） and high dose DST （HDDST） were carried out in 67 cases of CS with surgically confirmed cases in recent 3 years （from January 2011 to November 2015 ）. The serum eortisol and 24 h UFC were collected simultaneously for each subject and the sensitivity and specificity of serum cortisol and 24 h UFC were compared. Results There were Cushing disease （CD） group （ n = 53 ）, ectopic adrenoeorticotropic hormone （ACTH） syndrome group （ n = 7 ） and ACTH-independent Cushing syndrome group （ n = 7 ） according to the etiology of hypereorticordism. There were no significant differences among 3 groups in gender and age. The sensitivity of serum cortisol of different cut off points （50, 110, 140 nmol/L and 50% of control）after LDDST was 97.01% , 86. 57% , 83.58% and 70. 15% respectively. Meanwhile, the sensitivity of cutoff point of 24 h UFC 〈 32 nmol in combined LDDST was 92. 54% in the diagnosis of Cushing syndrome. There was no significant differences in two groups between serum eortisol 〈 110 nmol/L and 24 h UFC 〈 32 nmol. However, the sensitivity of serum cortisol 〈50 nmol/L was significantly higher than 24 h UFC 〈 32 nmol （ P 〈 0. 05 ）. Furthermore, in combined HDDST, if the suppression rate was ≥50%, the sensitivity of serum cortisol and 24 h UFC in differentiating the etiology of Cushing disease was 60. 38% and 90. 57%, and the specificity was 91.43% and 96. 00% respectively. There were significant differences between serum cortisol and 24 h UFC in both of sensitivity and specificity （ both P 〈 0. 05）. In addition, if the suppression rate of 24 h UFC in HDDST was adjusted to 60. 85% according to receiver operating characteristic （ROC） curve, it could have the best levels of sensitivity （92. 6% ） with the

关 键 词：库欣综合征 地塞米松抑制试验 分泌ACTH的脑垂体腺瘤 ACTH综合征 异位 敏感性与特异性 

分 类 号：R586.2[医药卫生—内分泌]