摘要
目的评价诊断库欣综合征时多种临床试验方法的敏感性和特异性.方法在173例临床确诊库欣综合征患者中进行血、尿皮质醇测定,血皮质醇昼夜节律观察和地塞米松抑制试验,并与术后病理结果进行比较.结果库欣综合征患者血皮质醇节律消失者为92.9%,其中二点法节律消失率为85.1%(8:00,16:00)及91.8%(8:00,24:00),三点法为94.7%(8:00,16:00,24:00).尿游离皮质醇(UFC)升高者为94.7%.小剂量地塞米松抑制试验不能抑制者为79.7%(1mg)和84.3%(2mg).血皮质醇基础值升高者为75.6%.库欣病患者行8mg地塞米松抑制试验,以抑制率50%为标准时,敏感性为50%～70%,特异性高于95%.结论诊断库欣综合征敏感性最强的检测指标为血皮质醇昼夜节律的消失和UFC增高.血皮质醇昼夜节律用三点法评价较二点法敏感性高.8mg地塞米松抑制试验是鉴别库欣病和肾上腺皮质腺瘤最合适的方法.
Objective To evaluate the sensitivity and specificity of various assays in diagnosing Cushing＇s syndrome. Methods The plasma cortisol, urinary free cortisol （UFC） , circadian rhythm in cortisol secretion and dexamethasone suppression test were assessed in 173 patients clinically diagnosed Cushing＇s syndrome. The data were compared with the postoperative pathologic diagnosis. Results The normal diurnal rhythm of cortisol secretion was lost in 92.9% patients with Cushing＇ s syndrome. The loss of normal diurnal rhythm of cortisol secretion of 2 time points occurred in 85.1% （8：00, 16：00） and 91.8% （8：00, 24：00） , and that of 3 time points （8：00, 16：00, 24：00） in 94.7% of the cases. The excretion of UFC was increased in 91.7% of patients with Cushing＇s syndrome. Low-dose dexarnethasone did not suppress the excessive secretion of glucocorticoid in 79.7% （ 1 mg） and 84.3% （2 mg） patients with Cushing＇s syndrome. The basal level of plasma cortisol was raised in 75.6% patients. The sensitivity of 8 mg dexamethasone suppression test was 50%-70% as the standard was set at 50% suppression, and specificity was more than 95%. Conclusion The most sensitive tests for Cushing＇s syndrome are the loss of normal circadian rhythm of cortisol secretion and increased UFC. The method of 3 time points is more sensitive than that of 2 time points in the assessment of circadian rhythm. The 8 mg dexamethasone suppression test is the most useful method in differentiating Cushing＇s disease from adrenal adenoma.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2005年第5期402-404,共3页
Chinese Journal of Endocrinology and Metabolism
基金
上海市教委重点学科建设经费(2001年度)
