外周DDAVP刺激试验在ACTH依赖性库欣综合征鉴别诊断中的价值  

Diagnostic value of peripheral DDAVP irritant test in the differential diagnosis of ACTH-dependent Cushing syndrome

作　　者：杨彩彩 郭清华[1] 窦京涛[1] 王先令[1] 吕朝晖[1] 谷伟军[1] 程愈[1] 杨国庆[1] 杜锦[1] 巴建明[1] 母义明[1] Yang Cai-Cai;Guo Qing-Hua;Dou Jing-Tao;Wang Xian-Ling;Lv Zhao-Hui;Gu Wei-Jun;Cheng Yu;Yang Guo-Qing;Du Jin;Ba Jian-Ming;Mu Yi-Ming(Department of Endocrinology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Endocrinology,the First Hospital of Yulin,Yulin,Shaanxi 719000,China)

机构地区：[1]解放军总医院第一医学中心内分泌科,北京100853 [2]榆林市第一医院内分泌科,陕西榆林719000

出　　处：《解放军医学杂志》2021年第6期587-592,共6页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金面上项目(81570705);海南省重点研发项目(ZDYF2018117);三亚科技创新项目(2017YW16);海南省卫计委课题(15A200071)。

摘　　要：目的分析外周1-去氨基-8-D-精氨酸血管加压素(DDAVP)刺激试验鉴别诊断库欣病与异位促肾上腺皮质激素(ACTH)综合征(EAS)的最佳截断点,探讨外周DDAVP刺激试验在ACTH依赖性库欣综合征鉴别诊断中的价值。方法回顾性分析2016年1月-2019年12月在解放军总医院第一医学中心内分泌科确诊的ACTH依赖性库欣综合征的102例患者的临床资料,其中库欣病组93例,EAS组9例。通过受试者工作特征(ROC)曲线,以刺激后血ACTH水平为检测变量,以是否为库欣病为状态变量,寻找诊断库欣病的最佳截断值。以不同切点探讨外周DDAVP刺激试验鉴别库欣病与EAS的敏感度及特异度。结果与库欣病组比较,EAS组病程较短,基础血皮质醇及血ACTH较高,差异均有统计学意义(P<0.05)。ROC曲线中以外周DDAVP刺激后血ACTH升高≥33.6%为切点鉴别诊断库欣病与EAS的敏感度、特异度分别为98.9%及55.6%,为最佳截断值。随着刺激后血ACTH的升高,诊断库欣病的敏感度下降,若同时以刺激后血皮质醇升高幅度≥20.0%为切点,诊断库欣病的敏感度下降,特异度未见升高,故血ACTH较血皮质醇特异度更高。若以外周DDAVP刺激后血ACTH升高≥33.6%,以及经典大剂量地塞米松抑制试验(HDDST)血皮质醇抑制率(或尿游离皮质醇抑制率)≥50.0%为切点,鉴别ACTH依赖性库欣综合征的敏感度和特异度分别为73.3%和87.5%。结论以外周DDAVP刺激后血ACTH升高≥33.6%为切点,诊断库欣病的敏感度最高,可作为库欣病的筛查试验,提高库欣病的检出率。Objective To analyze the peripheral 1-de-amino-8-D-arginine vasopressin(hereinafter referred as DDAVP)irritant test as the best cut-off point for the differential diagnosis of Cushing’s disease and ectopic adreno-cortico-tropic-hormone(ACTH)syndrome(hereinafter referred as EAS),so as to explore the value of peripheral DDAVP irritant test in differential diagnosis of ACTH-dependent Cushing’s syndrome.Methods The clinical data of 102 cases with ACTH-dependent Cushing’s syndrome,diagnosed in the Endocrinology Department of the First Medical Center of Chinese PLA General Hospital from January 2016 to December 2019,were retrospectively analyzed,including 93 cases with Cushing’s disease(Cushing’s disease group)and 9 cases with EAS(EAS group).Based on the ROC curve,the blood ACTH level after stimulation was used as the detection variable,and the diagnosis result of Cushing’s disease was used as the status variable to search the best cut-off point for the diagnosis of Cushing’s disease.The sensitivity and specificity were analyzed of the peripheral DDAVP irritant test in the differential diagnosis of EAS and Cushing’s disease at different cut-off points.Results Compared with Cushing’s disease group,the course of disease was shorter and the basic blood cortisol and ACTH values were higher in EAS group with statistical significance(P<0.05).On the ROC curve,taking the increase by 33.6%of ACTH after stimulation as the cut-off point,the sensitivity and specificity for Cushing’s disease and EAS were 98.9%and 55.6%,respectively,which were the best cut-off point.With the increase of blood ACTH value after stimulation,the sensitivity for diagnosing Cushing’s disease decreased.If the increase by 20.0%of blood cortisol value after stimulation as the cut-off point simultaneously,then,the sensitivity for diagnosing Cushing’s disease decreased and the specificity not increased.Thus,the blood ACTH was more specific than the blood cortisol.If taking the increase by 33.6%of the blood ACTH after peripheral DDAVP st

关 键 词：DDAVP刺激试验 库欣病 促肾上腺皮质激素 异位ACTH综合征 ACTH依赖性库欣综合征 

分 类 号：R584[医药卫生—内分泌]