库欣综合征的脂代谢特征及相关性研究

Serum lipid profile and correlations of lipids in patients with Cushing's syndrome:a retrospective analysis of 301 cases

目的探讨库欣综合征(Cushing’s syndrome,CS)患者的血脂谱特征、脂肪异常分布特点及其相关因素。方法分析解放军总医院内分泌科1992年12月至2012年5月期间住院确诊的301例CS患者的血脂水平、脂肪异常分布情况,对不同类型CS的血脂谱、脂肪异常进行对比和相关性分析。结果本组CS血脂谱异常的发生率72.43%,TG、TC、LDL-C、HDL-C异常的发生率分别为40.86%、60.33%、38.14%、7.44%。ACTH依赖性CS组较ACTH非依赖性CS组病程长,向心性肥胖、血脂异常更显著(P<0.05),但血脂谱2组无统计学差异(P>0.05)。TG、TC、LDL-C、HDL-C及脂肪异常分布均与血皮质醇水平显著正相关(P<0.05)。LDL-C与基础尿游离皮质醇独立正相关(P<0.05)。结论 CS病例脂代谢异常的发生率高,HDL-C水平多表现为正常或升高,基础尿游离皮质醇是LDL-C独立相关因素。

Objective To investigate the serum lipid profile,abnormal regional fat distribution,and related factors of lipid metabolism disorders in the patients with Cushing＇s syndrome（ CS）. Methods A total of 301 patients suffering from CS admitted in the endocrine department in Chinese PLA General Hospital from December 1992 to May 2012 were subjected in this study. Their serum lipid levels and abnormal distribution of fat were analyzed. The serum lipid profile and abnormal distribution were compared among different types of CS. The related factors of lipid metabolism disorder were analyzed too. Results The rate of dyslipidemia in this cohort was 72. 43%. The rates of abnormal serum levels of TG,TC,LDL-C and HDL-C（ increased and /or decreased） were 40. 86%,60. 33%,38. 14% and 7. 44% respectively. Adrenocorticotropic hormone（ ACTH）-dependent CS group had longer course,and more obviously central obesity and dyslipidemia than the non-ACTH independent CS group（ P〈 0.05）,though there was no statistical difference in serum lipid profile between them（ P〈 0.05）. Serum levels of TG,TC,LDL-C and HDL-C and abnormal regional fat distribution was positively correlated with serum cortisol level（ P〈 0.05）,and LDL-C and urinary free cortisol were independently in positive correlation（ P〈 0.05）. Conclusion The incidence of abnormal lipid metabolism is quite high in the CS patients. The serum level HDL-C is normal or increasing. Urinary free cortisol is the independent factor of LDL-C.