CAJ | 학술논문

目的 ACTH非依赖性库欣综合征术后糖皮质激素替代方案及其影响因素分析.方法纳入2003 ～2013年瑞金医院内分泌科临床诊断为ACTH非依赖性库欣综合征,病理明确为肾上腺皮质腺瘤患者181例.通过评估术前内分泌水平、影像学及临床随访资料,分析术后糖皮质激素替代剂量及替代时间的影响因素.结果所有患者术中及术后均需要激素替代,醋酸可的松平均替代时间为12个月(6～ 15个月),平均替代累积剂量为(8.12±5.07)g.Spearman相关性分析显示发病年龄分别与术后激素替代时间(r=0.250,P=0.010)及激素替代累积剂量(r=0.244,P=0.013)呈正相关,进一步行多元逐步回归分析提示发病年龄是术后可的松替代时间及替代剂量的独立影响因素(P＜0.05).术后ACTH先于皮质醇恢复并在术后9个月达到高峰,当肾上腺皮质功能恢复正常后ACTH降至正常范围.2.88％(3/104)患者出现激素撤退综合征.库欣综合征体征、体重指数、血压、血糖及血脂在术后半年内得到显著改善.结论 ACTH非依赖性库欣综合征术后需要醋酸可的松替代,发病年龄越大的患者术后激素替代时间越长并且累积剂量越大.激素减量过程中需注意激素撤退综合征的发生.
목적 ACTH비의뢰성고흔종합정술후당피질격소체대방안급기영향인소분석.방법 납입2003 ～2013년서금의원내분비과림상진단위ACTH비의뢰성고흔종합정,병리명학위신상선피질선류환자181례.통과평고술전내분비수평、영상학급림상수방자료,분석술후당피질격소체대제량급체대시간적영향인소.결과 소유환자술중급술후균수요격소체대,작산가적송평균체대시간위12개월(6～ 15개월),평균체대루적제량위(8.12±5.07)g.Spearman상관성분석현시발병년령분별여술후격소체대시간(r=0.250,P=0.010)급격소체대루적제량(r=0.244,P=0.013)정정상관,진일보행다원축보회귀분석제시발병년령시술후가적송체대시간급체대제량적독립영향인소(P＜0.05).술후ACTH선우피질순회복병재술후9개월체도고봉,당신상선피질공능회복정상후ACTH강지정상범위.2.88％(3/104)환자출현격소철퇴종합정.고흔종합정체정、체중지수、혈압、혈당급혈지재술후반년내득도현저개선.결론 ACTH비의뢰성고흔종합정술후수요작산가적송체대,발병년령월대적환자술후격소체대시간월장병차루적제량월대.격소감량과정중수주의격소철퇴종합정적발생.
Objective To investigate the preoperative factors in influencing the postoperative steroid replacement in patients with ACTH-independent Cushing's syndrome.Methods One hundred and eighty-one patients with adrenal cortical adenoma underwent unilateral adrenalectomy from 2003 to 2013.All preoperative and postoperative follow-up clinical parameters were acquired and analyzed.Results All patients need glucocorticoid (GC) replacement during and after surgery.At the median follow-up of 32 months (14-64 months),104 patients withdrew the cortisone acetate replacement,with a median replacement duration of 12 months (6-15 months) and an average cumulative dosage of(8.12 ± 5.07) g.Spearman correlation analysis showed that the age at diagnosis was positively correlated with the duration of GC replacement therapy (r =0.250,P =0.010) as well as the cumulative dosage of GC(r=0.244,P =0.013).Multiple stepwise regression analysis indicated that age at diagnosis was the independent factor that influenced both the duration and cumulative dosage of postoperative cortisone acetate replacement(P＜0.05).Plasma ACTH levels gradually increased and peaked during the 9th month,there was a lag of several months in the recovery of normal adrenal responsiveness.After that period,corticosteroid rose to normal levels,and followed by plasma ACTH concentrations,which fell to normal.2.88％ (3/104) of the patients presented with steroid withdrawal syndrome (SWS).Most features of hypercortisolism resolved within 6 months after surgery.Conclusion An empirical experience in Ruijin hospital in using cortisol replacement therapy for patients with ACTH-independent Cushing's syndrome after unilateral adrenalectomy was herewith reported.The older patients tended to prolong the replacement therapy of steroids and thus had to deal with a larger cumulative dosage.We should be aware of the risk of development of SWS postoperatively.