CAJ | 학술논문

目的：探讨不同判别标准下午夜血清皮质醇水平在库欣综合征诊断中的价值。方法2007－2012年解放军第四一一医院确诊74例库欣综合征患者，检测其8∶00、24∶00血清皮质醇、24 h尿游离皮质醇、8∶00血促肾上腺皮质激素（ adre-nocorticotropic hormore ，ACTH）及血钾，结果与同期确诊的75例非库欣超重／肥胖及84例非肥胖患者比较。以睡眠和清醒2种状态行午夜静脉抽血。结果（1）睡眠状态下行午夜血清皮质醇检测的库欣综合征组8∶00、24∶00血清皮质醇及尿游离皮质醇高于超重／肥胖及非肥胖对照组。清醒状态下的库欣综合征组8∶00、24∶00血清皮质醇及尿游离皮质醇高于超重／肥胖及非肥胖对照组，超重／肥胖组24∶00血清皮质醇高于非肥胖组。（2）睡眠状态下午夜血清皮质醇水平为50、138、207、229、331 nmol／L时，对库欣综合征诊断的敏感性分别为100．0％、97．1％、85．7％、77．1％及68．6％，特异性分别为24．1％、75．9％、86.1％、92．4％及98．7％。清醒状态下上述各水平的诊断敏感性分别为100．0％、97．4％、92．3％、84．6％及71．8％，特异性分别为11.3％、67．5％、82．5％、87．5％及96．3％。结论睡眠状态下夜血清皮质醇水平为207 nmol／L、清醒状态下为207 nmol／L或229 nmol／L时有较好的诊断敏感性及特异性。
목적：탐토불동판별표준하오야혈청피질순수평재고흔종합정진단중적개치。방법2007－2012년해방군제사일일의원학진74례고흔종합정환자，검측기8∶00、24∶00혈청피질순、24 h뇨유리피질순、8∶00혈촉신상선피질격소（ adre-nocorticotropic hormore ，ACTH）급혈갑，결과여동기학진적75례비고흔초중／비반급84례비비반환자비교。이수면화청성2충상태행오야정맥추혈。결과（1）수면상태하행오야혈청피질순검측적고흔종합정조8∶00、24∶00혈청피질순급뇨유리피질순고우초중／비반급비비반대조조。청성상태하적고흔종합정조8∶00、24∶00혈청피질순급뇨유리피질순고우초중／비반급비비반대조조，초중／비반조24∶00혈청피질순고우비비반조。（2）수면상태하오야혈청피질순수평위50、138、207、229、331 nmol／L시，대고흔종합정진단적민감성분별위100．0％、97．1％、85．7％、77．1％급68．6％，특이성분별위24．1％、75．9％、86.1％、92．4％급98．7％。청성상태하상술각수평적진단민감성분별위100．0％、97．4％、92．3％、84．6％급71．8％，특이성분별위11.3％、67．5％、82．5％、87．5％급96．3％。결론수면상태하야혈청피질순수평위207 nmol／L、청성상태하위207 nmol／L혹229 nmol／L시유교호적진단민감성급특이성。
Objective To explore the value of different assessment criteria of midnight serum cortisol in the diagnosis of Cushing′s syndrome (CS).Methods Seventy-four patients were diagnosed to have CS in No .411 hospital, CPLA, from 2007-2012. Serum cortisol levels at 08:00 and 24:00, urinary free cortisol level ( UFC) at 24 h and the levels of adrenocorticotropic hormore (ACTH) and potassium at 08:00 were detected in the said 74 cases of Cushing′s syndrome.Then, the obtained results were compared with those of the 75 overweight/obesity cases without CS and 84 non-overweight cases ( control group ) .Blood samples were collected at midnight for the detection of serum cortisol in the sleeping mode and awake status .Results (1) In the patients with CS, the levels of serum cotisol and urinary free cortisol detected at 8:00 and 24:00 in sleeping mode were higher than those overweight /obesity cases and the control group .In these same patients , the levels of serum cotisol and urinary free cortisol detected at 8:00 and 24:00 in the awake mode were also higher than those overweight/obesity cases and the control group .Serum cortisol level detected at 24:00 in the patients of the overweight/obesity group was higher than that of the control group .(2) When serum cotisol levels detected in the sleeping mode at 24:00 were respectively 50, 138, 207, 229 and 331 nmol/L, the detection sensitivity to CS was 100.0%, 97.1%, 85.7%, 77.1%and 68.6%, while the detection specificity was 24.1%, 75.9%, 86.1%, 92.4%and 98.7%.On the other hand, the de-tection sensitivity to CS in the awake status , was respectively 100.0%, 97.4%, 92.3%, 84.6%and 71.8%;and the detection specific- <br> ity was 11.3%, 67.5%, 82.5%, 87.5% and 96.3%.Conclusion The serum cortisol level of 207 nmol/L detected at 24:00 in the sleeping mode and the level of 207 nmol/L or 229 nmol/L detected in the awake status displayed better sensitivity and higher specificity .