围手术期激素快速撤退疗法对于肾上腺皮质腺瘤所致库欣综合征的临床治疗效果观察

The rapid tapering glucocorticoids replacement perioperatively on adrenocortical adenoma related Cushing's syndrome:aprospective study

目的探讨围手术期激素提前撤退对于ACTH-非依赖型库欣综合征患者的治疗效果,重点研究该疗法是否能够满足术后患者激素需要量及其治疗效果。方法本试验收集2010年2月至2013年1月瑞金医院收治的38例肾上腺皮质腺瘤所致库欣综合征患者,其中18例围手术期给予激素快速撤退补充治疗,另外20例则给予传统激素补充方案,收集患者术前、术后及随访临床资料并研究。结果两组患者治疗方案术前、术后总体预后相似,但围手术期激素快速撤退疗法能够明显降低患者术后住院天数[(5.83±0.75)]vs.(8.25±1.28)d,P<0.01],同时能够缩减激素完全时间[(8.70±3.89)vs.(10.22±3.07)月,P<0.05]。结论肾上腺皮质腺瘤所致库欣综合征围手术期给予激素快速撤退疗法安全有效,且能够更快地完全撤退外源性激素补充,临床上值得推广。

Objective To prospectively investigate the safety of rapid tapering glucocorticoids supplementation perioperatively for the treatment of Cushing＇s syndrome caused by adrenocortical adenoma. Methods A total of 38 patients with adrenocortical adenoma caused Cushing＇s syndrome were enrolled, who were treated during Feb. 2010 and Jan. 2013. Of all patients, 18 received novel rapid tapering regimen （group A）, and the other 20 were Supplied with conventional tapering dose （group B）. The regimen of group A was reduced fast till the maintenance within 4 days, while it was gradually decreased within nearly 2 weeks. Results The rapid tapering regimen could significantly reduce the duration of hospital stay from （8.25±1.28） d in conventional group to （5.83±0.75）d of group A （P〈0.01）. With similar curative effects achieved, it could also help to shorten the cortisol withdrawal duration, which was （8.70±3.89） for group A and （10.22±3.07） months for group B. The difference was significant （P〈0. 05）. Conclusions The rapid cortisol tapering perioperatively is safe, effective and beneficial for patients with Cushing＇s Syndrome caused by adrenocortical adenoma undergoing adrenalectomy.