核增殖指数MIB-1在肾上腺皮质癌诊断和预后判断中的价值  

Study on predictive value of MIB-1 in the diagnosis and prognosis of adrenocortical carcinoma

作　　者：邓建华[1] 王站 刘义 文进[1] 张玉石[1] Deng Jianhua;Wan Zhan;Liu Yi;Wen Jin;Zhang Yushi(Department of Urology,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泌尿外科,北京100730

出　　处：《中华泌尿外科杂志》2024年第4期294-298,共5页Chinese Journal of Urology

基　　金：中央高水平医院临床科研业务费(2022-PUMCH-B-010)。

摘　　要：目的探讨核增殖指数(MIB-1)在肾上腺皮质癌(ACC)诊断和预后判断中的价值。方法回顾性分析2018年6月至2022年8月北京协和医院收治的ACC患者和肾上腺良性病变患者的临床资料。ACC组59例,男25例,女34例,男女比例1:1.4。年龄(46.1±2.1)岁,其中<20岁4例,21~30岁7例,31~40岁11例,41~50岁14例,51~60岁13例,61~70岁8例,>70岁2例。体质量指数(24.3±2.4)kg/m^(2)。收缩压(149.3±5.2)mmHg(1mmHg=0.133kPa),舒张压(93.4±1.7)mmHg。典型库欣综合征表现51例,高血压52例,血糖升高44例,低钾血症16例,雄激素分泌致月经异常和痤疮16例。实验室检查:血糖(7.2±0.3)mmol/L,糖化血红蛋白(8.6±1.4)%,总胆固醇(5.7±0.3)mmol/L,三酰甘油(2.0±0.3)mmol/L。24h尿游离皮质醇(234.4±39.0)μg/24h,其中46例升高。8:00时促肾上腺皮质激素(9.5±4.1)pg/ml,其中48例下降。血游离皮质醇(401.2±17.1)μg/dl,其中42例节律消失。醛固酮升高17例。硫酸脱氢表雄酮(713±159)μg/dl,其中16例升高。神经烯醇化酶(21.2±5.3)ng/ml,其中27例升高。胰岛素样生长因子-1(272.0±42.1)ng/ml,其中26例升高。46例行大、小剂量地塞米松抑制试验均不被抑制。39例肿瘤为功能性。59例术前行腹盆腔增强CT、MRI、B超检查,21例行PET/CT检查。肿瘤位于左侧32例,右侧26例,双侧1例。肿瘤最大径(9.6±1.7)cm,其中≤10cm43例,>10cm16例。伴淋巴结转移5例,远处转移16例,局部侵犯11例。肿瘤临床分期Ⅰ期(T_(1)N_(0)M_(0)期)4例,Ⅰ期(T_(2)N_(0)M_(0)期)27例,Ⅲ期T_(1~2)N_(1)M_(0)期、T_(3)N_(0)M_(0)期23例,Ⅳ期(T_(1~4)N_(0~1)M_(1)期、T_(3)N_(1)M_(0)期、T_(4)N_(0~1)M_(0)期)5例。伴肾上腺中央静脉、肾静脉、下腔静脉瘤栓6例。对照组53例,均为肾上腺皮质良性病变患者,男26例,女27例。年龄(44.3±3.2)岁,典型库欣综合征表现28例,24h尿游离皮质醇(176.4±41.2)μg/24h。27例游离皮质醇节律消失。硫酸脱氢表雄酮正常。23例行大、小剂量地塞米松抑制Objective To explore the value of nuclear proliferation index(MIB-1)in the diagnosis and prognosis of adrenal cortical carcinoma(ACC).Methods A retrospective analysis was conducted on the clinical data of ACC patients and patients with benign adrenal lesions admitted to Beijing Union Medical College Hospital from June 2018 to August 2022.There were 59 cases in the ACC group,25 males and 34 females,with a male to female ratio of 1:1.4.Age(46.1±2.1)years old,including 4 cases under 20 years old,7 cases between 21-30 years old,11 cases between 31-40 years old,14 cases between 41-50 years old,13 cases between 51-60 years old,8 cases between 61-70 years old,and 2 cases over 70 years old.Body mass index(24.3±2.4)kg/m^(2).Systolic blood pressure(149.3±5.2)mmHg(1 mmHg=0.133 kPa)and diastolic blood pressure(93.4±1.7)mmHg.There were 51 cases of typical Cushings syndrome,52 cases of hypertension,44 cases of elevated blood sugar,16 cases of hypokalemia,and 16 cases of menstrual abnormalities and acne caused by androgen secretion.Laboratory examination:Blood glucose(7.2±0.3)mmol/L,glycated hemoglobin(8.6±1.4)%,total cholesterol(5.7±0.3)mmol/L,and triglycerides(2.0±0.3)mmol/L.24-hour urine free cortisol(234.4±39.0)μg/24 h,with 46 cases showing an increase,and at 8am,corticotropin releasing hormone(9.5±4.1)pg/ml,with 48 cases showing a decrease.Blood free cortisol(401.2±17.1)μg/dl,with 42 cases of rhythm disappearance.17 cases showed elevated aldosterone levels.Dehydroepiandrosterone sulfate(713±159)μg/dl,of which 16 cases increased.Neuroenolase(21.2±5.3)ng/ml,of which 27 cases were elevated.Insulin like growth factor-1 was(272.0±42.1)ng/ml,with 26 cases showing an increase.46 routine high-dose and lowdose dexamethasone inhibition tests were not suppressed.39 cases of tumors were functional.59 cases underwent preoperative abdominal and pelvic contrast-enhanced CT,MRI,and B-ultrasound examination,and 21 cases underwent PET/CT examination.The tumors were located in 32 cases on the left,26 cases on the right,and 1

关 键 词：肾上腺皮质癌 核增殖指数 诊断 预后 

分 类 号：R736.6[医药卫生—肿瘤]