中华内分泌代谢杂志
中華內分泌代謝雜誌
중화내분비대사잡지
CHINESE JOURNAL OF ENDOCRINOLOGY AND METABOLISM
2013年
2期
135-139
,共5页
唐志清%朱笑笑%王先令%杜锦%杨国庆%欧阳金芝%谷伟军%郭清华%金楠
唐誌清%硃笑笑%王先令%杜錦%楊國慶%歐暘金芝%穀偉軍%郭清華%金楠
당지청%주소소%왕선령%두금%양국경%구양금지%곡위군%곽청화%금남
库欣病%大剂量地塞米松抑制试验%临床表现%影像特点
庫訢病%大劑量地塞米鬆抑製試驗%臨床錶現%影像特點
고흔병%대제량지새미송억제시험%림상표현%영상특점
Cushing's disease%High-dose dexamethasone suppression test%Clinical manifestations%Imaging features
目的 分析经典大剂量地塞米松抑制试验(high-dose dexamethasone suppression test,HDDST) 不同抑制率的库欣病患者临床和生化特点.方法 回顾性分析1991至2011年在解放军总医院诊治的202例库欣病患者临床资料,根据HDDST结果将患者分为抑制组(抑制率≥50%)和非抑制组(抑制率<50%),抑制组又根据抑制率再分为A组(≥80%)和B组(50% ~ 80%),比较3组间临床、生化和影像特点的异同.结果 (1)本组资料中,23.3%的患者HDDST中不被抑制,抑制组中A、B亚组分别占53.4%和23.3%.与抑制组-A和B比较,非抑制组病程更短、血钾水平更低.(2)库欣病常见体征中,非抑制组紫纹和下肢水肿较抑制组-A更多见;高血压和低钾血症的发生率明显高于抑制组(包括A、B亚组,P<0.01),但糖代谢紊乱仅较抑制组-A更多见(P<0.05).抑制组的亚组中,抑制组-B低钾血症更多见(P<0.05).(3)非抑制组血清ACTH、游离皮质醇和24 h尿游离皮质醇均显著高于抑制组(包括A、B亚组),对抑制组的亚组进一步分析只有8:00的血清皮质醇以抑制组-B更高(P<0.05).(4)3组垂体MRI阴性率无明显差异,阳性改变中以垂体瘤直接征象更常见;肾上腺影像特点中以双侧增生最多见,非抑制组有增多的趋势,但无显著性;肾上腺没有明显增生样改变在各组也没有显著差异,当表现为单侧增生时3组均以左侧多见,尤其是抑制组-A.结论 尽管抑制率不同,除抑制组-B的8:00血清皮质醇更高和低钾血症多见外,抑制组各亚组间的其他临床、生化和影像特点相似,而非抑制组则具有更高的激素水平、更短的病程、更突出的体征和严重的生化异常.
目的 分析經典大劑量地塞米鬆抑製試驗(high-dose dexamethasone suppression test,HDDST) 不同抑製率的庫訢病患者臨床和生化特點.方法 迴顧性分析1991至2011年在解放軍總醫院診治的202例庫訢病患者臨床資料,根據HDDST結果將患者分為抑製組(抑製率≥50%)和非抑製組(抑製率<50%),抑製組又根據抑製率再分為A組(≥80%)和B組(50% ~ 80%),比較3組間臨床、生化和影像特點的異同.結果 (1)本組資料中,23.3%的患者HDDST中不被抑製,抑製組中A、B亞組分彆佔53.4%和23.3%.與抑製組-A和B比較,非抑製組病程更短、血鉀水平更低.(2)庫訢病常見體徵中,非抑製組紫紋和下肢水腫較抑製組-A更多見;高血壓和低鉀血癥的髮生率明顯高于抑製組(包括A、B亞組,P<0.01),但糖代謝紊亂僅較抑製組-A更多見(P<0.05).抑製組的亞組中,抑製組-B低鉀血癥更多見(P<0.05).(3)非抑製組血清ACTH、遊離皮質醇和24 h尿遊離皮質醇均顯著高于抑製組(包括A、B亞組),對抑製組的亞組進一步分析隻有8:00的血清皮質醇以抑製組-B更高(P<0.05).(4)3組垂體MRI陰性率無明顯差異,暘性改變中以垂體瘤直接徵象更常見;腎上腺影像特點中以雙側增生最多見,非抑製組有增多的趨勢,但無顯著性;腎上腺沒有明顯增生樣改變在各組也沒有顯著差異,噹錶現為單側增生時3組均以左側多見,尤其是抑製組-A.結論 儘管抑製率不同,除抑製組-B的8:00血清皮質醇更高和低鉀血癥多見外,抑製組各亞組間的其他臨床、生化和影像特點相似,而非抑製組則具有更高的激素水平、更短的病程、更突齣的體徵和嚴重的生化異常.
목적 분석경전대제량지새미송억제시험(high-dose dexamethasone suppression test,HDDST) 불동억제솔적고흔병환자림상화생화특점.방법 회고성분석1991지2011년재해방군총의원진치적202례고흔병환자림상자료,근거HDDST결과장환자분위억제조(억제솔≥50%)화비억제조(억제솔<50%),억제조우근거억제솔재분위A조(≥80%)화B조(50% ~ 80%),비교3조간림상、생화화영상특점적이동.결과 (1)본조자료중,23.3%적환자HDDST중불피억제,억제조중A、B아조분별점53.4%화23.3%.여억제조-A화B비교,비억제조병정경단、혈갑수평경저.(2)고흔병상견체정중,비억제조자문화하지수종교억제조-A경다견;고혈압화저갑혈증적발생솔명현고우억제조(포괄A、B아조,P<0.01),단당대사문란부교억제조-A경다견(P<0.05).억제조적아조중,억제조-B저갑혈증경다견(P<0.05).(3)비억제조혈청ACTH、유리피질순화24 h뇨유리피질순균현저고우억제조(포괄A、B아조),대억제조적아조진일보분석지유8:00적혈청피질순이억제조-B경고(P<0.05).(4)3조수체MRI음성솔무명현차이,양성개변중이수체류직접정상경상견;신상선영상특점중이쌍측증생최다견,비억제조유증다적추세,단무현저성;신상선몰유명현증생양개변재각조야몰유현저차이,당표현위단측증생시3조균이좌측다견,우기시억제조-A.결론 진관억제솔불동,제억제조-B적8:00혈청피질순경고화저갑혈증다견외,억제조각아조간적기타림상、생화화영상특점상사,이비억제조칙구유경고적격소수평、경단적병정、경돌출적체정화엄중적생화이상.
Objective To analyze the clinical and biochemical characteristics of Cushing's disease with differeut suppression rates by high-dose dexamethasone.Methods Two hundred and two consecutive patients with Cushing's disease were divided into three groups according to the response to the high-dose dexamethasone suppression test (HDDST):non-suppressed group (suppression rate <50%),suppressed group A (suppression rate ≥ 80%) and suppressed group B (suppression rate 50%-80%).Results (1) Of the 202 patients,non-suppressed group was seen in 23.3% (47/202),meanwhile suppressed group A and B accounted for 53.4% and 23.3% respectively.Compared with both suppressed group A and B,non-suppressed group had shorter duration and lower serum potassium level(P<0.01).(2) Patients in non-suppressed group presented a higher prevalence of striae,edema of lower limbs and disorder of glucose metabolism as compared with the patients in suppressed group A.On the other hand,patients in non-suppressed group were more likely to suffer from hypertension and hypokalemia than those in both suppressed group A and B.Further analysis of prevalence of hypokalemia in suppressed group revealed significantly higher prevalence rate of hypokalemia in suppressed group B (P<0.05).(3) Patients in non-suppressed group also had significantly higher baseline plasma ACTH,cortisol,and 24 h urinary free cortisol than those in both suppressed group A and B.Patients in suppressed group A presented significantly higher baseline plasma cortisol levels (8:00) as compared with patients in suppressed group B.(4) Pituitary MRI revealed no significant difference among the 3 groups,and the direct signs of pituitary tumor were more common in patients with positive pituitary imaging.Bilateral hyperplasia was the most common imaging feature of adrenal glands,and it tended to be more common of patients in non-suppressed group.No significant difference was found in findings of normal-like adrenal gland among three groups.However,unilateral hyperplasia was more common on the left,especially in the suppressed group A.Conclusion There were no significant differences in the clinical and biochemical characteristics of Cushing's disease in both suppressed group A and B,except for a significant higher serum cortisol at 8:00 and prevalence of hypokalemia in suppressed group B.The patients in non-suppressed group presented higher levels of the hormone,shorter duration,more typical signs of Cushing' s disease and severe biochemical abnormalities as compared with suppressed groups.