双侧岩下窦静脉采血诊断ACTH依赖性库欣综合征的价值

The value of bilateral inferior petrosal sinus sampling in the differential diagnosis of ACTH-dependent Cushing＇s syndrome

目的评估双侧岩下窦静脉采血（BIPSS）测定ACTH、垂体MRI动态增强和大剂量地塞米松抑制试验在ACTH依赖性库欣综合征鉴别诊断中的价值。方法纳入BIPSS并经病理明确诊断的ACTH依赖性库欣综合征患者87例，行BIPSS、大剂量地塞米松抑制试验和垂体影像学评估。结果78例病理明确诊断为垂体ACTH瘤，9例为胸腺类癌所致异位ACTH综合征。大剂量地塞米松抑制试验、垂体MRI动态增强和BIPSS诊断敏感性分别为82．1％、79．5％和92．3％，特异性分别为100％、44．4％和100％，诊断准确率分别为83．9％、77．0％和93．1％。库欣病患者BIPSS分侧定位符合率为83．9％，而垂体MRl分侧定位符合率为64．5％。结论ACTH依赖性库欣综合征中，BIPSS比大剂量地塞米松抑制试验、垂体MRI动态增强诊断符合率更高。与垂体MRI检查相比，BIPSS分侧定位更为可信。

Objective To evaluate the values of bilateral inferior petrosal sinus sampling （ BIPSS ）, high dosage dexamethasone suppression test （HDDST） and pituitary image in the differential diagnosis of ACTH-dependent Cushing＇s syndrome. Methods Totally 87 patients with confirmed pathological diagnosis were recruited in the study. All received the procedure of BIPSS, HDDST, and pituitary MRI with dynamic enhancement. The diagnostic performances of three differential diagnosis methods in ACTH-dependent Cushing＇s syndrome were evaluated. Results Seventy-eight patients were diagnosed as cases of pituitary ACTH adenoma, and the remaining 9 were confirmed cases of ectopic ACTH syndrome due to the thymic carcinoid. The sensitivity and specificity of HDDST, pituitary MRI, and BIPSS for the diagnosis of ACTH-dependent Cushing＇s syndrome were 82. 1% and 100% , 79.5% and 44.4% , 92.3% and 100% ,respectively. In Cushing＇s disease, the diagnostic accuracy was 83.9% with HDDST, 77.0% with pituitary MRI, and 93.1% with BIPSS. In those patients with Cushing＇s disease, the coincidence of lateralization was 83.9% with BIPSS and 64. 5% with MRI. Conclusion BIPSS was better than the other two methods in differential diagnosis of ACTH-dependent Cushing＇s syndrome. Compared with the pituitary MRI, the concordant rate of BIPSS in lateralization of the tumor is higher, and it is more reliable.