中剂量地塞米松雄激素抑制试验在女性高雄激素血症中的诊断价值  

Efficacy of medium dose dexamethasone androgen suppression test in the diagnosis of female hyperandrogenism

作　　者：戴好 卢琳 邢小平 王林杰 段炼 姜君[5] 朱立[2] 李明[3] 宋爱羚[3] 杨国华[3] 郁琦[4] 田秦杰[4] 周远征[4] 陆召麟 Dai Hao;Lu Lin;Xing Xiaoping;Wang Linjie;Duan Lian;Jiang Jun;Zhu Li;Li Ming;Song Ailing;Yang Guohua;Yu Qi;Tian Qinjie;Zhou Yuanzheng;Lu Zhaolin(Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences ＆ Peking Union Medical College, Beijing 100730, China)

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 国家卫生和健康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 北京协和医院核医学科,100730 [3]中国医学科学院北京协和医学院 北京协和医院核检验科,100730 [4]中国医学科学院北京协和医学院 北京协和医院妇产科,100730 [5]中国科学院北京基因组研究所

出　　处：《中华医学杂志》2018年第26期2073-2077,共5页National Medical Journal of China

基　　金：中国医学科学院医学与健康科技创新工程项目（2017-I2M-1-011）

摘　　要：目的评价中剂量地塞米松雄激素抑制试验（DAST）在女性高雄激素血症中的诊断价值。方法回顾性分析北京协和医院内分泌科1984年1月至2017年12月85例高雄激素血症的女性患者行中剂量DAST的结果，包括55例先天性肾上腺皮质增生症（CAH）、10例分泌雄激素肿瘤和20例多囊卵巢综合征（PCOS），评估诊断价值。结果41例和19例CAH患者分别进行1日法和5日法中剂量DAST，睾酮平均抑制率为77.9%和91.3%（P〈0.001），17OHP平均抑制率为95.2%和97.0% （P＝0.220）。在进行1日法DAST的不同病因高雄激素血症女性患者中（CAH 41例，雄激素肿瘤10例，PCOS 20例），诊断CAH的最佳睾酮抑制率为61.2%（灵敏度87.8%，特异度96.7%）；最佳17OHP抑制率为87.1%（灵敏度95.1%，特异度为93.3%）。结论在CAH患者中，1日法和5日法中剂量DAST的17OHP抑制率无明显差异，两种方法均可用于CAH的诊断。1日法DAST可作为女性高雄激素血症患者中CAH和非CAH病因的鉴别检查。ObjectiveTo evaluate the diagnostic value of medium dose dexamethasone androgen suppression tests （DAST） in female hyperandrogenism. MethodsDAST results were retrospectively analyzed in 85 cases of women with hyperandrogenism including 55 cases of congenital adrenal hyperplasia （CAH）, 10 cases of testosterone-producing tumors and 20 cases of polycystic ovary syndrome （PCOS） between January 1984 and December 2017 in Peking Union Medical College Hospital. The suppression rate of testosterone and 17 hydroxyprogesterone （17OHP） were evaluated. The cut-off point of suppression rates were calculated by receiver operating characteristic （ROC） curve in the differential diagnosis of CAH and non-CAH causes.ResultsThe 1-day medium dose DAST was performed simultaneously in 41 cases of CAH patients and the 5-days medium dose DAST was performed simultaneously in 19 cases of CAH patients. The results indicated that the average suppression rate of testosterone were 77.9% and 91.3% （P〈0.001） and the average suppression rate of 17OHP was 95.2% and 97.0%, respectively （P=0.220）. In patients （41 cases of CAH, 10 cases of testosterone producing tumor and 20 cases of PCOS） with 1-day DAST, the optimal testosterone suppression rate was 61.2% （the sensitivity and specificity was 87.8% and 96.7%, respectively） and the optimal 17OHP suppression rate was 87.1% （the sensitivity and specificity was 95.1% and 93.3%, respectively） in the identification of CAH and non-CAH cases. There is no clinical significance between the testosterone and 17OHP suppression rate in the differential diagnosis of CAH and non-CAH cases.ConclusionsThere was no difference in the suppression rate of 17OHP between the 1-day and 5-days DAST in CAH cases. The sensitivity of suppression rate of 17OHP is equal in the differential diagnosis of hyperandrogenism. One-day approach DAST could be used as functional test for the diagnosis of the etilology of hyperandrogenism （CAH or non-CAH）.

关 键 词：雄激素增多症 肾上腺增生 先天性 多囊卵巢综合征 地塞米松雄激素抑制试验 分泌雄激素肿瘤 

分 类 号：R711.75[医药卫生—妇产科学]