肾上腺皮质癌及肾上腺皮质腺瘤患者血清肾上腺皮质激素谱的特点比较

Comparison the characteristics of serum adrenocortical hormone profile in patients with adrenal cortical carcinoma and adrenal coritcal adenoma

目的比较肾上腺皮质癌及肾上腺皮质腺瘤患者血清肾上腺皮质激素谱的特点。方法回顾性分析2018年1月至2022年6月于北京大学第一医院内分泌科和(或)泌尿外科就诊的肾上腺皮质癌患者23例、肾上腺皮质腺瘤患者119例,获取两组患者影像学特征,通过液相色谱串联质谱方法检测两组患者血清肾上腺皮质激素谱,比较两组的差异,采用多因素logistic回归模型分析与肾上腺皮质癌发生相关的可能因素。结果肾上腺皮质癌患者的年龄为46(35,57)岁,女性为15例(65.2%);肾上腺皮质腺瘤患者年龄为49(40,58)岁,女性为80例(67.2%);两组患者年龄及性别构成差异无统计学意义(均P>0.05)。影像学检查发现,肾上腺皮质癌患者的肿瘤最大径M(Q_(1),Q_(3))(下同)为7.05(5.45,9.78)cm,比肾上腺皮质腺瘤患者大[2.1(1.6,3.0)cm](P<0.001);雄烯二酮[4.0569(1.6195,7.9079)比1.5175(0.9351,2.5821)nmol/L(P<0.001)]升高,11-酮睾酮/11-酮雄烯二酮[0.0343(0.0206,0.0792)比0.0410(0.0286,0.0615)(P=0.089)]、11-酮雄烯二酮/11-羟雄烯二酮[0.0130(0.0064,0.0867)比0.0630(0.0182,0.1625)(P=0.042)]降低。多因素分析发现雄烯二酮、肿瘤最大径、11-酮睾酮/11-酮雄烯二酮、11-酮雄烯二酮/11-羟雄烯二酮是发生肾上腺皮质癌的相关因素,OR值(95%CI)分别为1.841(1.093~3.100)、5.130(2.332~11.285)、0.381(0.167~0.867)、0.000(0.000~0.014),均P<0.05。结论肾上腺皮质肿瘤直径越大、雄烯二酮水平升高是肾上腺皮质癌的相关因素;11-羟雄烯二酮转换生成11-酮雄烯二酮及11-酮雄烯二酮转换生成11-酮睾酮减低与肾上腺皮质癌相关。

Objective To compare the characteristics of serum adrenocortical hormone profiles detected by liquid chromatography tandem mass spectrometry in patients with adrenal cortical carcinoma and adrenal adenoma.Methods A total of 23 patients with adrenal cortical carcinoma and 119 patients with adrenal cortical adenoma/hyperplasia who visited the Department of Endocrinology and/or the Department of Urology of Peking University First Hospital from January 2018 to June 2022 were analyzed retrospectively.The imaging characteristics and serum adrenal cortical hormone profiles detected by liquid chromatography tandem mass spectrometry were analyzed retrospectively.The independent related factors of adrenal cortical carcinoma were screened by univariate analysis and multivariate logistic regression analysis.Results The age of patients with adrenal cortical carcinoma was 46(35,57)years,and 15(65.2%)were female;The age of adrenal cortical adenoma patients was 49(40,58)years old,and 80(67.2%)were female.There was no significant difference in age and gender between the two groups(all P values>0.05).The maximum tumor diameter M(Q_(1),Q_(3))of patients with adrenocortical carcinoma was 7.05(5.45,9.78)cm,which was larger than that of patients with adrenocortical adenoma[2.1(1.6,3.0)cm](P<0.001).Compared with patients with adrenal adenoma,the androstenedione(AD)of patients with adrenal cortical carcinoma[4.0569(1.6195,7.9079)nmol/L vs 1.5175(0.9351,2.5821)nmol/L(P<0.001)]was significantly increased;11-ketotestosterone/11-ketoandrostenedione[0.0343(0.0206,0.0792)vs 0.0410(0.0286,0.0615)(P=0.089)]and 11-ketoandrostenedione/11-hydroxyandrostenedione[0.0130(0.0064,0.0867)vs 0.0630(0.0182,0.1625)(P=0.042)]were significantly decreased.Multivariate analysis found that AD,the largest diameter of the tumor,11-ketotestosterone/11-ketoandrostenedione and 11-ketoandrostenedione/11-hydroxyandrostenedi-one were related factors for adrenal cortical carcinoma,with OR values(95%CI)of 1.841(1.093-3.100),5.130(2.332-11.285),0.381(0.167-0.867)and 0.000(0.000-0.014),respectively,all P values<0.05.Conclusions The larger diameter of adrenal cortical tumor and the higher the level of androstenedione are independent risk factors for adrenal cortical carcinoma.The reduction conversion of 11-hydroxyandrostenedione to 11-ketoandrostenedione and 11-ketoandrostenedione to 11-ketotestosterone were independently associated with adrenal cortical carcinoma.