亚临床库欣综合征临床及生化特征分析

Analyses of clinical and biochemical features in subclinical Cushing＇ s syndrome

目的评价。肾上腺意外瘤中亚临床库欣综合征的临床及生化特征，以及各项检查方法在亚临床库欣综合征诊断中的作用。方法对45例亚临床库欣综合征患者进行8、24h血皮质醇、尿游离皮质醇检测，同时进行8h血促肾上腺皮质激素及2mg地塞米松抑制试验（dexamethasone suppression test，DST），将结果与51例肾上腺无功能瘤患者比较。结果（1）亚临床库欣综合征组腹型肥胖、高血压、高血糖及脂代谢紊乱的患病率均高于肾上腺无功能瘤组，腰围、收缩压及血三酰甘油高于无功能瘤组患者，根据ATPⅢ标准，2组代谢综合征患病率分别为31．1％（14／45）及11．8％（6／51）；（2）各项生化检查对于亚临床库欣综合征诊断的敏感性由高至低依次为2mg DST不抑制（100．0％）、24h血皮质醇升高（77．8％）、尿游离皮质醇升高（46．7％）及8h血皮质醇升高（40．0％）；特异性以2mg DST不抑制及8h血皮质醇升最高（94．1％）最好，其次为尿游离皮质醇升高（84．3％），24h血皮质醇最低（74．5％）。结论亚临床库欣综合征患者代谢综合征相关症状的患病率升高，可对患者造成一定危害，在其各项检测指标中，2mg DST不抑制和24h血皮质醇升高具有较好的临床价值。

Objective To evaluate the clinical and biochemical features of subclinical Cushing＇ s syndrome （SCS） and the sensitivity and specificity of various diagnostic methods in SCS. Methods Forty-five cases of SCS underwent abdominal computed tomography scan, plasma cortisol, urinary free cortisol and dexamethasone suppression tests （DST）. Then, results were compared with those of the 51 patients with nonfunction adrenal adenoma （NAA）. Results （ 1 ） As defined by Adult Treatment Panel Ⅲ criteria, the prevalence of metabolic syndrome （MS） was 31.1% in patients with SCS and 11.8% in patients with NAA. The prevalence of abdominal obesity, hypertension, hyperglycemia and disturbance of lipid in SCS patients was higher than that of the patients with NAA. Waist circumference, systolic blood pressure and plasma triglyceride for patients with SCS were larger than those of the patients with NAA. （2） Sensitivity of various laboratory tests for patients with SCS was listed below in the numerical order （from high to low ）： 2 mg dexamethasone suppression test （DST） （ 100.00% ）, 24 h plasma cortisol （77.8%）, 24 h urinary free cortisol （46.7%） and 8 h plasma cortisol （40.0%）. The specificity for 2 mg DST and elevation of 8 h plasma cortisol were most ideal （94.1%） , next were the elevation of urinary cortisol and 24 h plasma cortisol （84.3% and 74.5% ）. Conclusions Some patients with SCS have such metabolic syndromes, as abdominal obesity, hypertension, hyperglycemia and disturbance of lipid. The 2 mg dexamethasone non-suppression test and the elevation of 24 h plasma cortisol were of better clinical value in the diagnosis of SCS.