CAJ | 학술논문

目的比较不同病因库欣综合征患者心脑血管并发症和临床特点.方法回顾性分析1991年至2011年在解放军总医院确诊的284例库欣综合征患者临床资料,根据病理结果分组,比较库欣病(CD)、肾上腺腺瘤(AA)、异位ACTH综合征(EAS)3组间心脑血管并发症和临床特点.结果 (1)本组患者平均年龄(37.7±l2.3)岁(16 ～ 76岁),EAS组年龄更大[(45.1±16.4)岁(16 ～68岁,P＜O.05)]、病程更短[2个月(1～3个月,P＜0.05)]；CD组、AA组及EAS组发生低血钾的比例分别为44.9％、32.3％、100％(两两比较均P＜0.05)；(2)EAS组更易发生碱中毒、下肢水肿,较少出现紫纹(P＜0.05);AA组色素沉着及痤疮发生率显著降低(P＜0.01)；(3) EAS组不同时点的血ACTH、皮质醇和24 h尿游离皮质醇水平均显著升高,AA组最低,且3组之间两两比较具有统计学差异(P＜0.05)；(4) EAS组和CD组总的血管并发症发生率相近(68.8％对59.2％,P＞0.05),但均较AA组(43.4％)显著升高(P＜0.05).与AA组比较,CD组总心血管并发症(43.8％对31.3％)和总脑血管并发症(13.1％对6.1％)均显著升高(P＜0.05),分别以心律失常(33.7％对22.2％)和脑梗死(13.1％对5.1％)为著(p＜0.05).3组间肾功能损害未见统计学意义(P＞0.05).经多因素logistic回归分析显示低血钾与CD组血管并发症呈正相关、血钾水平与之呈负相关.而与AA组和EAS组不具有相关性.结论 EAS组发病年龄更大、病程更短,激素水平更高,更易出现低血钾、碱中毒、下肢水肿及色素沉着.库欣综合征患者血管并发症发生率高,其中CD组的总心、脑血管并发症均较AA组显著升高,以心律失常和脑梗死为著.3组间肾功能损害未见统计学意义.低血钾是CD组发生血管并发症的危险因素.
목적 비교불동병인고흔종합정환자심뇌혈관병발증화림상특점.방법 회고성분석1991년지2011년재해방군총의원학진적284례고흔종합정환자림상자료,근거병리결과분조,비교고흔병(CD)、신상선선류(AA)、이위ACTH종합정(EAS)3조간심뇌혈관병발증화림상특점.결과 (1)본조환자평균년령(37.7±l2.3)세(16 ～ 76세),EAS조년령경대[(45.1±16.4)세(16 ～68세,P＜O.05)]、병정경단[2개월(1～3개월,P＜0.05)]；CD조、AA조급EAS조발생저혈갑적비례분별위44.9％、32.3％、100％(량량비교균P＜0.05)；(2)EAS조경역발생감중독、하지수종,교소출현자문(P＜0.05);AA조색소침착급좌창발생솔현저강저(P＜0.01)；(3) EAS조불동시점적혈ACTH、피질순화24 h뇨유리피질순수평균현저승고,AA조최저,차3조지간량량비교구유통계학차이(P＜0.05)；(4) EAS조화CD조총적혈관병발증발생솔상근(68.8％대59.2％,P＞0.05),단균교AA조(43.4％)현저승고(P＜0.05).여AA조비교,CD조총심혈관병발증(43.8％대31.3％)화총뇌혈관병발증(13.1％대6.1％)균현저승고(P＜0.05),분별이심률실상(33.7％대22.2％)화뇌경사(13.1％대5.1％)위저(p＜0.05).3조간신공능손해미견통계학의의(P＞0.05).경다인소logistic회귀분석현시저혈갑여CD조혈관병발증정정상관、혈갑수평여지정부상관.이여AA조화EAS조불구유상관성.결론 EAS조발병년령경대、병정경단,격소수평경고,경역출현저혈갑、감중독、하지수종급색소침착.고흔종합정환자혈관병발증발생솔고,기중CD조적총심、뇌혈관병발증균교AA조현저승고,이심률실상화뇌경사위저.3조간신공능손해미견통계학의의.저혈갑시CD조발생혈관병발증적위험인소.
Objective To compare the cardiovascular and cerebrovascular complications and clinical characteristics in patients with Cushing's syndrome of various aetiologies.Methods Two hundred and eighty-four consecutive patients with Cushing's syndrome were included and divided into three groups according to aetiologies:Cushing's disease group (CD),adrenal adenoma group (AA),ectopic ACTH syndrome group (EAS).Results (1) Of the 284 patients,the mean age was(37.7 ± 12.3) years(16-76 years),while in EAS group it was(45.1 ±16.4) years (16-68 years,P ＜0.05).Patients in EAS group had shorter duration of illness (1-3 months).Hypokalemia was present in 44.9％,32.3％,100％ of patients in CD group,AA group,and EAS group respectively.(2) Patients in EAS group were more susceptible to alkalosis and edema of lower limbs,and had lower prevalence of striae (P＜0.05) ; AA group had lower prevalence of pigmentation and acne(P＜0.01).(3) Patients in EAS group had significantly higher baseline plasma ACTH,cortisol,and 24 h urine free cortisol levels than those in CD group and AA group.(4) Patients in EAS group and CD group had similar prevalences of overall vascular complications(68.8％ vs 59.2％,P＞0.05),which were significantly higher than that in AA group(43.4％,P＜0.05).Compared with AA group,patients in CD group had higher prevalence of cardiovascular complications (43.8％ vs 31.3％) and cerebrovascular complications (13.1％ vs 6.1％,P＜0.05),manifesting as cardiac arrhythmia(33.7％ vs 22.2％) and cerebral infarction (13.1％ vs 5.1％,P ＜0.05).No significant difference in the prevalence of impaired renal function in three groups was found (P ＞ 0.05).Multivariate logistic regression analysis revealed that the incidence of hypokalemia was positively correlated with vascular complication in group CD,but serum potassium level was negatively correlated with vascular complication.Conclusion Patients in EAS group were older and had shorter duration of illness,and higher levels of hormone,and were more susceptible to hypokalemia,alkalosis edema of lower limbs,and pigmentation.Patients in CD group had higher prevalence of cardiovascular and cerebrovascular complications than that in AA group,especially arrhythmias and cerebral infarction.No significant difference in the incidence of impaired renal function was found among three groups.Hypokalemia might be the independent risk factor of vascular complications in CD group.