X线引导下双侧岩下窦取血联合去氨加压素刺激试验对垂体术后或放疗后复发及无效的促肾上腺皮质激素依赖性库欣综合征的诊断意义  

The value of X-ray guided desmopressin stimulated bilateral inferior petrosal sinus sampling in diagnosing the recurrence of ACTH dependent Cushing disease or ineffectiveness of surgery or radiotherapy

作　　者：姜晓东 张晓波[2] 卢琳[3] 金征宇[2] 王志伟[2] 顾峰[3] 陆召麟[3] 曾正陪[3] 李晓光[2] 刘巍[2] 潘杰[2] 石海峰[2] 杨宁[2] 王任直[4] Jiang Xiaodong Zhang Xiaobo Lu Lin Jin Zhengyu Wang Zhiwei Gu Feng Lu Zhaolin Zeng Zhengpei Li Xiaoguang Liu Wei Pan Jie Shi Haifeng Yang Ning Wang Renzhi(Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China)

机构地区：[1]赤峰医学院附属医院神经外科,024000 [2]中国医学科学院北京协和医学院北京协和医院放射科,100730 [3]中国医学科学院北京协和医学院北京协和医院内分泌科,100730 [4]中国医学科学院北京协和医学院北京协和医院神经外科,100730

出　　处：《中华放射学杂志》2016年第10期794-797,共4页Chinese Journal of Radiology

摘　　要：目的：探讨双侧岩下窦取血（IPSS）过程中联合去氨加压素（DDAVP）刺激试验，对垂体术后或放疗后复发或症状不缓解的促肾上腺皮质激素（ACTH）依赖性库欣综合征的诊断意义。方法回顾性分析行IPSS＋DDAVP刺激试验的垂体术后或放疗后复发（31例）或症状不缓解（3例）的ACTH依赖性库欣综合征患者的临床资料。研究排除造影显示岩下窦与海绵窦不通者。经双侧岩下窦造影显示海绵窦插管成功。取血测定岩下窦与外周静脉血样ACTH浓度比值，基础比值≥2或刺激后比值≥3提示病变来源于垂体即库欣病。将取血结果与金标准诊断（意大利下丘脑-垂体-肾上腺轴研究组所制定的标准）进行比较，评价岩下窦取血对垂体术后或放疗后复发或无效的ACTH依赖性库欣综合征的诊断意义。结果30例患者岩下窦与外周静脉血ACTH浓度基础比值≥2或DDAVP刺激后比值≥3，提示病变位于垂体。其中22例手术证实为垂体ACTH腺瘤；8例未行手术，经鞍区伽马刀治疗后症状明显缓解，证实病变位于垂体。4例患者岩下窦与外周静脉血ACTH浓度基础比值〈2且刺激后比值〈3，提示病变不在垂体。其中1例经垂体手术证实为ACTH腺瘤，3例手术证实为肺类癌,术后临床症状缓解。IPSS＋DDAVP刺激诊断库欣病的敏感度为96.8%，特异度为100%，准确性为97.1%。结论IPSS＋DDAVP刺激试验对垂体术后或放疗后复发或无效的ACTH依赖性库欣综合征有重要的鉴别诊断意义。Objective To investigate the value of X-ray guided desmopressin （DDAVP） stimulated bilateral inferior petrosal sinus sampling （IPSS） in diagnosing the recurrence of ACTH dependent Cushing disease or ineffectiveness after surgery or radiotherapy. Methods Retrospective analyses of patients with recurrent ACTH dependent Cushing disease （31 cases） or ineffective （3 cases） treatment after surgery or radiotherapy from January 2013 to October 2014 in our hospital was conducted. Bilateral inferior petrosal sinus angiography showed the same side of the cavernous sinus to prove successful intubation. The cases＆amp;nbsp;with discontinuous of the inferior petrosal sinus and cavernous sinus were excluded by this study. Finally, there were 34 cases of the patients in this study. Diagnosis was based on the ratio of ACTH level in IPS to peripheral vein after desmopressin test.The gradient≥2 at baseline or gradient≥3 after desmopressin test suggested the sources were in the pituitary. Diagnosis was confirmed by gold standard to investigate the value of X-ray guided desmopressin （DDAVP） stimulated bilateral IPSS. Results The IPS gradient≥2 at baseline or gradient≥3 after desmopressin test suggested the sources were in the pituitary in 30 patients. A total of 22 （22/30） patients underwent surgery with a final diagnosis of ACTH adenoma. The symptoms were obviously relieved in 8 （8/30） cases after sellar area gamma knife treatment and lesions were confirmed in the pituitary. IPS gradient〈2 at baseline or gradient〈3 after desmopressin test was found in 4 cases. One case （1/4） was found to have for ACTH adenoma after pituitary surgery. The other 3 cases （3/4） were confirmed to have lung carcinoid and clinical symptom alleviated after surgery. The sensitivity of desmopressin stimulated IPSS was 96.8%, the specificity was 100%, and the accuracy was 97.1%. Conclusion Desmopressin stimulated IPSS is an effective diagnostic procedure in diagnosing ACTH dependent Cushing disease recurrence or

关 键 词：库欣综合征 ACTH综合征 异位 诊断 岩下窦取样 

分 类 号：R586.2[医药卫生—内分泌] R816.6[医药卫生—内科学]