午夜血清皮质醇水平对Cushing综合征诊断价值的初步探讨

Preliminary Evaluation of Midnight Serum Cortisol Level in Diagnosis of Cushing Syndrome

【目的】初步探讨午夜血清皮质醇水平对Cushing综合征的诊断价值。【方法】回顾分析我院1997年12月到2007年4月收治的42例Cushing综合征患者和134例经住院检查排除Cushing综合征的肥胖症和高血压病患者,比较不同午夜血清皮质醇水平切点对Cushing综合征诊断的敏感性和特异性。【结果】以690 nmol/L(正常高限)为切点,08:00血清皮质醇水平对Cushing综合征诊断的敏感性和特异性分别为52.4%和94.0%;以08:00血清皮质醇水平的75%为切点,16:00血清皮质醇水平的敏感性和特异性分别为73.8%和72.4%;而对于24:00血清皮质醇水平,以08:00血清皮质醇水平的75%以及207、138和50 nmol/L为切点,对诊断Cushing综合征的敏感性分别为64.3%、95.2%、100.0%和100.0%,特异性分别为95.5%、93.3%、83.6%和53.0%。【结论】午夜血清皮质醇水平以207 nmol/L为切点具有较高的敏感性和特异性,对于Cushing综合征具有较高的诊断价值。

[Objective] To preliminarily investigate the value of midnight serum cortisol level in diagnosis of Cushing syndrome. [Methods] Forty-two patients with Cushing syndrome and 134 patients with simple obesity or essential hypertension in whom Cushing syndrome was excluded were studied retrospectively to compare the sensitivity and specificity of the different midnight serum cortisol cut-off levels. [Results] The sensitivity and specificity of the cut-off level of 690 nmol/L for 8：00 serum cortisol level were 52.4% and 94.0%, respectively. For 16：00 serum cortisol level, the sensitivity and specificity of 75% of the serum cortisol level at 08：00 were 73.8% and 72.4%, respectively. The sensitivity of 75% of the serum cortisol level at 08：00 and of the cut-off levels of 207, 138, and 50 nmol/L for 24：00 serum cortisol level were 64.3%, 95.2%, 100.0%, and 100.0%, respectively, and the specificity were 95.5%, 93.3%, 83.6%, and 53.0%, respectively. [Conclusions] The cut-off level of 207 nmol/L for midnight serum cortisol level, with high sensitivity and specificity, has excellent effectiveness for the diagnosis of Cushing syndrome.