不同判别标准评价午夜血清皮质醇水平在库欣综合征诊断中的价值

Value of different assessment criteria of midnight serum cortisol in the diagnosis of Cushing's syndrome

目的探讨不同判别标准下午夜血清皮质醇水平在库欣综合征诊断中的价值。方法 2007-2012年解放军第四一一医院确诊74例库欣综合征患者,检测其8∶00、24∶00血清皮质醇、24 h尿游离皮质醇、8∶00血促肾上腺皮质激素(adrenocorticotropic hormore,ACTH)及血钾,结果与同期确诊的75例非库欣超重/肥胖及84例非肥胖患者比较。以睡眠和清醒2种状态行午夜静脉抽血。结果 (1)睡眠状态下行午夜血清皮质醇检测的库欣综合征组8∶00、24∶00血清皮质醇及尿游离皮质醇高于超重/肥胖及非肥胖对照组。清醒状态下的库欣综合征组8∶00、24∶00血清皮质醇及尿游离皮质醇高于超重/肥胖及非肥胖对照组,超重/肥胖组24∶00血清皮质醇高于非肥胖组。(2)睡眠状态下午夜血清皮质醇水平为50、138、207、229、331nmol/L时,对库欣综合征诊断的敏感性分别为100.0%、97.1%、85.7%、77.1%及68.6%,特异性分别为24.1%、75.9%、86.1%、92.4%及98.7%。清醒状态下上述各水平的诊断敏感性分别为100.0%、97.4%、92.3%、84.6%及71.8%,特异性分别为11.3%、67.5%、82.5%、87.5%及96.3%。结论睡眠状态下夜血清皮质醇水平为207 nmol/L、清醒状态下为207nmol/L或229 nmol/L时有较好的诊断敏感性及特异性。

Objective To explore the value of different assessment criteria of midnight serum cortisol in the diagnosis of Cushing＇s syndrome（ CS）. Methods Seventy-four patients were diagnosed to have CS in No. 411 hospital,CPLA,from 2007-2012.Serum cortisol levels at 08： 00 and 24： 00,urinary free cortisol level（ UFC） at 24 h and the levels of adrenocorticotropic hormore（ ACTH） and potassium at 08： 00 were detected in the said 74 cases of Cushing＇s syndrome. Then,the obtained results were compared with those of the 75 overweight / obesity cases without CS and 84 non-overweight cases（ control group）. Blood samples were collected at midnight for the detection of serum cortisol in the sleeping mode and awake status. Results（ 1） In the patients with CS,the levels of serum cotisol and urinary free cortisol detected at 8： 00 and 24： 00 in sleeping mode were higher than those overweight / obesity cases and the control group. In these same patients,the levels of serum cotisol and urinary free cortisol detected at 8： 00 and 24： 00 in the awake mode were also higher than those overweight / obesity cases and the control group. Serum cortisol level detected at 24： 00 in the patients of the overweight / obesity group was higher than that of the control group.（ 2） When serum cotisol levels detected in the sleeping mode at 24： 00 were respectively 50,138,207,229 and 331 nmol / L,the detection sensitivity to CS was 100. 0%,97. 1%,85. 7%,77. 1% and 68. 6%,while the detection specificity was 24. 1%,75. 9%,86. 1%,92. 4% and 98. 7%. On the other hand,the detection sensitivity to CS in the awake status,was respectively 100. 0%,97. 4%,92. 3%,84. 6% and 71. 8%; and the detection specificity was 11. 3%,67. 5%,82. 5%,87. 5% and 96. 3%. Conclusion The serum cortisol level of 207 nmol / L detected at 24： 00 in the sleeping mode and the level of 207 nmol / L or 229 nmol / L detected in the awake status displayed better sensitivity and higher specificity.