血清硫酸脱氢表雄酮在库欣综合征病因鉴别诊断中的应用  

The value of serum dehydroepiandrosterone sulfate in differential diagnosis of Cushing′s syndrome

作　　者：刘梦思 张文婧 朱科盈 陈焕 冯文焕[1] 朱大龙[1] 李平[1] Liu Mengsi;Zhang Wenjing;Zhu Keying;Chen Huan;Feng Wenhuan;Zhu Dalong;Li Ping(Department of Endocrinology,Drum Tower Hospital Affiliated to Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院内分泌科,南京210008

出　　处：《中华医学杂志》2020年第36期2822-2827,共6页National Medical Journal of China

基　　金：江苏省自然科学基金项目(BK20181116)。

摘　　要：目的:评估血清硫酸脱氢表雄酮(DHEAS)水平在不同库欣综合征病因中的变化及其鉴别诊断价值。方法:回顾性分析南京大学医学院附属鼓楼医院内分泌科2012年1月至2019年6月确诊的库欣病(CD)36例(男8例,女28例,平均年龄44岁),肾上腺性库欣综合征(ACS)64例(男6例,女58例,平均年龄39岁),以及同期诊治的肾上腺无功能瘤(NFA)97例患者临床资料。比较三组患者以及促肾上腺皮质激素(ACTH)抑制与非抑制ACS患者的一般资料、血清DHEAS水平及校正性别、年龄的DHEAS比值变化,采用受试者工作特征(ROC)曲线评估DHEAS及其比值在库欣综合征病因鉴别诊断中的价值。结果:与NFA相比,ACS患者血清DHEAS水平[0.39(0.39,0.63)μmol/L比2.96(1.92,4.60)μmol/L,P<0.01]及DHEAS比值[0.58(0.27,0.98)比3.95(3.08,6.83),P<0.01]均更低,CD患者血清DHEAS水平[6.49(4.32,11.63)μmol/L]及其比值[9.17(4.49,15.41)]均更高(均P<0.01)。根据基础血浆ACTH水平,将ACS患者分为ACTH抑制组(ACTH<2.2 pmol/L)(53例,82.8%)及非抑制组(ACTH≥2.2 pmol/L)(11例,17.2%)。ACTH非抑制组患者24 h尿游离皮质醇水平低于ACTH抑制组[(1299±511)nmol/24 h比(1972±876)nmol/24 h,P=0.04]。ACTH抑制组与非抑制组患者DHEAS水平及DHEAS比值差异均无统计学意义(均P>0.05)。两组患者DHEAS水平及DHEAS比值均低于CD患者(均P<0.01)。血清DHEAS及DHEAS比值作为鉴别诊断ACS和CD指标的ROC曲线下面积分别为0.997、0.990。血清DHEAS水平鉴别诊断ACS和CD的最佳切点为2.06μmol/L,灵敏度97.5%,特异度100%;DHEAS比值诊断的最佳切点为2.10,灵敏度95.0%,特异度100%。结论:血清DHEAS水平及其比值在ACS和CD患者中存在明显差异,可以作为两种主要库欣综合征病因鉴别的指标,特别是在ACTH非抑制的ACS及CD患者的鉴别中更具优势。Objective To evaluate the changes and diagnostic value of serum dehydroepiandrosterone sulfate(DHEAS)in Cushing′s syndrome(CS)with different etiologies.Methods The study retrospectively recruited patients diagnosed as CS in Drum Tower Hospital affiliated to Nanjing University Medical School between January 2012 and June 2019,including 36 patients(8 males,28 females,with an average age of 44 years)with Cushing disease(CD)and 64 patients(6 males,58 females,with an average age of 39 years)with adrenal CS(ACS).Meanwhile,97 patients diagnosed as nonfunctional adrenal adenoma(NFA)were also included as controls.Clinical characteristics,laboratory data,adrenocorticotropic hormone(ACTH),serum DHEAS level and sex-and age-adjusted DHEAS ratio of the three groups were collected.The sensitivity and specificity of DHEAS and its ratio in differential etiology diagnosis of CS were compared using receiver operating characteristic(ROC)curve analysis.Results Compared to NFA group,ACS patients had lower DHEAS levels[0.39(0.39,0.63)μmol/L vs 2.96(1.92,4.60)μmol/L,P<0.01]and lower DHEAS ratio[0.58(0.27,0.98)vs 3.95(3.08,6.83),P<0.01].DHEAS[6.49(4.32,11.63)μmol/L]and DHEAS ratio[9.17(4.49,15.41)]in CD patients were significantly higher compared to those in NFA and ACS patients(all P<0.01).There were 53 ACS patients(82.8%)with suppressed ACTH level(<2.2 pmol/L)and 11 patients(17.2%)with normal/high ACTH level(≥2.2 pmol/L).The level of 24 hour urine free cortisol in normal/high ACTH level group was lower than the suppressed ACTH group[(1299±511)nmol/24 h vs(1972±876)nmol/24 h,P=0.04].No significant differences were found in the DHEAS and DHEAS ratio between the two groups.ROC analysis showed that the area under the curve of serum DHEAS and DHEAS ratio in diagnosing ACS from CD was 0.997 and 0.990,respectively.The optimal cut-off values for DHEAS and its ratio were 2.06μmol/L and 2.10,respectively.The diagnostic sensitivity and specificity of DHEAS were 97.5%and 100%,and those of DHEAS ratio were 95.0%and 100%,respectively.Concl

关 键 词：库欣综合征 库欣病 硫酸脱氢表雄酮 鉴别诊断 

分 类 号：R586[医药卫生—内分泌] R446.1[医药卫生—内科学]