腺瘤型肾上腺源性皮质醇增多症不同病理类型的临床表现和激素谱特点  

Clinical manifestations and hormonal profile characteristics of different pathological types of adrenocortical adenoma hypercortisolism

作　　者：刘林[1] 陈仕炜 虢晶翠 余霄腾[2] 张争[2] 高莹[1] 张俊清[1] Liu lin;Chen Shiwei;Guo Jingcui;Yu Xiaoteng;Zhang Zheng;Gao Ying;Zhang Junqing(Department of Endocrinology,Peking University First Hospital,Beijing 100034,China;Department of Urology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院内分泌科,北京100034 [2]北京大学第一医院泌尿外科,北京100034

出　　处：《中华泌尿外科杂志》2024年第4期287-293,共7页Chinese Journal of Urology

基　　金：国家重点研发计划(2022YFC2505300);中央高水平医院临床科研业务费(2022CX08、2023IR25)。

摘　　要：目的探讨不同病理类型腺瘤型肾上腺源性皮质醇增多症患者的临床表现和血清肾上腺皮质激素谱的特点。方法去回顾性分析2018年1月至2022年6月北京大学第一医院收治的68例肾上腺源性库欣综合征患者的病例资料,其中12例术后病理检查示皮质腺瘤存在明显嗜酸性变(嗜酸性变组),56例无明显嗜酸性变(无嗜酸性变组)。嗜酸性变组男1例,女11例;年龄(49.83±9.87)岁;体质量指数(BMI)(25.86±3.21)kg/m^(2);收缩压(140.25±20.72)mmHg(1mmHg=0.133 kPa),舒张压(91.00±14.87)mmHg;显性库欣综合征7例。无嗜酸性变组男14例,女32例;年龄(52.91±10.82)岁,BMI(26.06±3.57)kg/m^(2);收缩压(142.13±16.71)mmHg,舒张压(83.63±11.41)mmHg;显性库欣综合征16例。两组上述指标比较差异均无统计学意义(P>0.05)。实验室检查,嗜酸性变组和无嗜酸性变组的24:00时皮质醇分别为14.95(5.93,23.2)ng/dl和6.69(4.07,11.35)ng/dl(P=0.044),1mg过夜地塞米松抑制试验后皮质醇分别为20.19(11.29,26.92)ng/dl和5.94(2.68,12.90)ng/dl(P=0.005),8:00、16:00、24:00时促肾上腺皮质激素(ACTH)分别为2.08(1.02,2.90)pg/ml和8.37(2.30,11.67)pg/ml(P=0.006)、1.22(1.00,3.20)pg/ml和4.22(1.80,6.33)pg/ml(P=0.012)0.65(0,2.63)pg/ml和2.76(1.44,5.57)pg/ml(P=0.023),三酰甘油分别为1.92(1.31,2.50)mmol/L和1.31(1.04,1.80)mmol/L(P=0.026),差异均有统计学意义。靶器官损害方面,嗜酸性变组和无嗜酸性变组合并心室壁肥厚分别为6例和10例(P=0.017),主动脉夹层分别为1例和0例(P=0.030),合并4种以上靶器官损伤分别为4例和5例(P=0.024),差异均有统计学意义。通过液相色谱-串联质谱方法检测两组术前血清肾上腺皮质激素谱,比较两组肾上腺皮质激素谱的差异和激素比值的差异,将年龄、性别和有统计学差异的指标纳入多因素logistic回归模型,分析各项指标与嗜酸性变的相关性。结果两组的肾上腺皮质激素谱显示,嗜酸性变组和无嗜酸性变组的血清雌酮Objective To explore the clinical manifestations and characteristics of serum adrenal cortex hormone spectrum in patients with adrenocortical hypercortisolism with different pathological types of adrenal adenoma.Methods A retrospective analysis was conducted on 68 patients with adrenal Cushings syndrome who underwent surgical treatment in the Department of Endocrinology and/or Urology,Peking University First Hospital from January 2018 to June 2022.Among them,12 patients had obvious eosinophilic changes in pathology(eosinophilic group),and 56 patients had no obvious eosinophilic changes(non-eosinophilic group).Among eosinophilic group,one male and 11 females,age(49.83±9.87)years old,body mass index(BMI)(25.86±3.21)kg/m^(2),systolic blood pressure(140.25±20.72)mmHg(1 mmHg=0.133 kPa),diastolic blood pressure(91.00±14.87)mmHg,7 cases were overt Cushing's syndrome.Among non-eosinophilic group,14 males and 32 females,age(52.91±10.82)years old,BMI(26.06±3.57)kg/m^(2);ystolic blood pressure(142.13±16.71)mmHg,diastolic blood pressure(83.63±11.41)mmHg;16 cases of overt Cushings syndrome.There was no statistically significant difference in the above indicators between the two groups(P>0.05).In terms of laboratory tests,0:00 cortisol levels in the eosinophilic group and non-eosinophilic groups were 14.95(5.93,23.2)ng/dl and 6.69(4.07,11.35)ng/dl(P=0.044),the cortisol levels after 1mg dexamethasone inhibition test were 20.19(11.29,26.92)ng/dl and 5.94(2.68,12.90)ng/dl(P=0.005),and 8:00,16:00,and 0:00,ACTH levels were 2.08(1.02,2.90)pg/ml and 8.37(2.30,11.67)pg/ml(P=0.006),1.22(1.00,3.20)pg/ml,and 4.22(1.80,6.33)pg/ml(P=0.012),0.65(0,2.63)pg/ml,and2.76(1.44,5.57)pg/ml(P=0.023),serum triglyceride were 1.92(1.31,2.50)mmol/L and 1.31(1.04,1.80)mmol/L(P=0.026),and the differences were statistically significant.In terms of target organ damage,there were 6 cases and 10 cases(P=0.017)in the eosinophilic group and non eosinophilic group with ventricular wall hypertrophy,1 case and 0 cases(P=0.030)in the aortic dissection group

关 键 词：肾上腺源性皮质醇增多症 肾上腺皮质腺瘤 肾上腺皮质激素谱 嗜酸性变 液相色谱-串联质谱 

分 类 号：R736.6[医药卫生—肿瘤]