精氨酸血管加压素刺激试验与大剂量地塞米松抑制试验在库欣病与异位促肾上腺皮质激素综合征诊断中的价值

Value of desmopressin stimulation test and high dose dexamethasone suppression testin the etiologic diagnosis of ACTH dependent Cushing＇s syndrome

目的 探讨精氨酸血管加压素（DDAVP）刺激试验与大剂量地塞米松抑制试验（HDDST）在促肾上腺皮质激素（ACTH）依赖性库欣综合征诊断中的临床价值.方法 回顾性收集2010年1月1日至2015年9月30日于华西医院确诊的85例库欣病和10例异位ACTH综合征患者的临床资料,分析DDAVP刺激试验与HDDST诊断库欣病的敏感性、特异性以及联合两试验结果对库欣病诊断的符合率.结果 DDAVP刺激试验的敏感性与特异性为87％（39/45）和5/5,HDDST的敏感性与特异性为79％ （67/85）和8/10,标准HDDST的敏感性高于过夜HDDST.上述两试验结果一致时对库欣病诊断的符合率为100％.结论 DDAVP刺激试验与HDDST对库欣病及异位ACTH综合征均有良好的诊断价值,两试验结合可进一步提高诊断的准确性.

Objective Toinvestigate the value of desmopressin （DDAVP）stimulation test and high dose dexamethasone suppression test （HDDST） inestablishing the cause of ACTH dependent Cushing＇s syndrome.Methods The clinical data of patients with ACTH dependent Cushing＇s syndrome at West China Hospital from January 1,2010 to September 30,2015 was analyzed.The sensitivity and specificity of DDAVP stimulation test,HDDST,and the diagnostic accordance rate when the two tests were combined,were evaluated based on the diagnostic gold standard.Results A total of 85 patients with Cushing＇s disease and 10 patients with ectopic ACTH syndrome were included.The sensitivity and specificity of DDAVP stimulation test were 87% and 5/5,respectively,whereas those of HDDST were 79% and 8/10,respectively.The standard high dose dexamethasone suppression test showed a higher sensitivity than overnight 8 mg dexamethasone suppression test.When the two tests had consistentresults,the diagnostic accordance rate was 100%.Conclusions DDAVP stimulation test and HDDST are both efficient modalities for the diagnosis of Cushing＇s Disease andectopic ACTH syndrome.The accuracy of diagnosis can be further improved by combining the two tests.