ACTH-F节律联合24小时尿游离皮质醇对肾上腺偶发瘤中亚临床库欣综合征的诊断价值  

Diagnostic value of ACTH-F rhythm combined with 24-hour UFC in subclinical Cushing′s syndrome in adrenal incidental tumors

作　　者：任敏 任蕾[2] REN Min;REN Lei(Department of Endocrinology,Xinyang Central Hospital,Xinyang 464000,Henan,China)

机构地区：[1]信阳市中心医院内分泌科,河南信阳464000 [2]郑州大学第一附属医院内分泌科,河南郑州450052

出　　处：《广东医学》2019年第23期3269-3272,共4页Guangdong Medical Journal

基　　金：2016年度河南省医学科技攻关计划项目(编号:162102310596)

摘　　要：目的研究促肾上腺皮质激素-皮质醇(ACTH-F)节律联合24 h尿游离皮质醇(24h-UFC)对肾上腺偶发瘤(adrenal incidentaloma, AI)中亚临床库欣综合征(subclinical Cushing′s syndrome,SCS)的临床诊断价值。方法回顾性分析诊治的103例伴有SCS的AI患者的临床病理资料(SCS组),以78例肾上腺无功能腺瘤(adrenal non-functional adenomas,NFA)作为对照组,应用受试者工作曲线(receiver operative characteristic curve,ROC)分析ACTH-F节律、24h-UFC的诊断价值。结果 SCS组与NFA组患者在肿瘤位置及合并症间差异有统计学意义(P<0.05),而在性别、年龄、体质指数及肿瘤直径间差异无统计学意义(P>0.05)。SCS组24h-UFC、F0:00、F8:00、F16:00均显著高于NFA组(P<0.05),SCS组ACTH0:00、ACTH8:00、ACTH16:00水平显著低于NFA组(P<0.05)。24h-UFC的曲线下面积(AUC)为0.727(95%CI:0.660~0.798),最佳切点为472 nmol,敏感度61%,特异度78.1%;F0:00、F8:00、F16:00的AUC分别为0.837、0.592、0.673,F0:00的最佳切点为118 nmol/L,诊断的敏感度为80.5%,特异度为77.4%。ACTH8:00的AUC为0.831,最佳切点为3.1 pmol/L时,诊断的敏感度为81.2%,特异度为74.1%。结论检测ACTH-F节律、24h-UFC对AI患者SCS的临床诊断具有重要价值,值得临床推广应用.Objective To study the clinical value of adrenocorticotropic hormone-cortisol(ACTH-F) rhythm combined with 24-hour urinary free cortisol(24 h-UFC) in the diagnosis of subclinical Cushing′s syndrome(SCS) in adrenal incidentaloma(AI). Methods The clinical and pathological data of 103 AI patients with SCS(Group SCS) were retrospectively analyzed. Seventy-eight adrenal non-functional adenomas(SFA) were used as control group. The receiver operative characteristic curve(ROC) was used to analyze the diagnostic value of ACTH-F rhythm and 24 h-UFC. Results There were significant differences in tumor location and comorbidity between Group SCS and Group NFA(P<0.05), but there was no significant difference in gender, age, body mass index or tumor diameter(P>0.05). The 24 h-UFC, F0:00, F8:00 and F16:00 were significantly higher in Group SCS than the Group NFA(P<0.05);while the ACTH0:00, ACTH 8:00 and ACTH 16:00 levels were significantly lower in Group SCS than the Group NFA(P<0.05). The area under the curve(AUC) of 24 h-UFC was 0.727(95%CI: 0.660~0.798), and the optimal cut point was 472 nmol with the sensitivity of 61% and specificity of 78.1%. The AUC of F0:00, F8:00 and F16:00 were 0.837, 0.592 and 0.673, respectively;and the optimal cut point of F0:00 was 118 nmol/L with the sensitivity of 80.5% and the specificity of 77.4%. The AUC of ACTH8:00 was 0.831, and the optimal cut point was 3.1 pmol/L with the sensitivity of 81.2% and the specificity of 74.1%.Conclusion The detection of ACTH-F rhythm and 24 h-UFC is of great value in the clinical diagnosis of SCS in patients with AI.

关 键 词：亚临床库欣综合征 肾上腺偶发瘤 皮质醇 诊断 

分 类 号：R586.2[医药卫生—内分泌] R446[医药卫生—内科学]