血促肾上腺皮质激素和尿游离皮质醇在库欣病患者术后长期疗效预测中的价值及比较

The value and comparison of plasma adrenocorticotropic hormone and urinary free cortisol in predicting long-term outcome after operation of Cushing＇s disease

目的 比较利用术后3 d内清晨血浆促肾上腺皮质激素（ACTH）和24 h尿游离皮质醇（24 h UFC）来预测库欣病术后长期疗效的价值。方法 对2012至2014年北京协和医院神经外科140例手术治疗、病理学诊断明确且围手术期内分泌检查完整的库欣病患者临床资料进行回顾性分析。采用单因素分析、多因素Logistic回归分析和ROC曲线等统计学方法，研究与术后血总皮质醇（F）相比，术后3 d内清晨血ACTH和24 h UFC预测手术长期疗效的价值和优劣。结果 单因素分析结果显示，在早缓解和未缓解两组间术前ACTH、术前24 h UFC、术后ACTH和术后24 h UFC差异均有统计学意义（P〈0.05，〈0.01，〈0.01）。多因素Logistic回归分析显示，在早缓解和未缓解的两组间术后ACTH和术后24 h UFC差异有统计学意义（P〈0.01，〈0.05）。ROC曲线分析显示术后ACTH和24 h UFC最佳临界值分别为4.11 pmol/L和281.42 nmol（102 μg）/24 h，曲线下面积（AUC）分别是0.917（P〈0.01）、0.814（P〈0.01），术后ACTH的评价效果优于24 h UFC（P〈0.01）。结论 术后3 d内清晨ACTH和24 h UFC可用来评价和预测库欣病术后长期疗效，术后ACTH的判断意义较24 h UFC更大。

Objective To study and the value of morning plasma adrenocorticotropic hormone （ACTH） and urinary free cortisol （24 h UFC） within 3 days after operation in patients with Cushing′s disease in predicting the long-term outcome.Methods The clinical data of 140 patients with Cushing′s disease who were treated in Department of Neurosurgery of PUMCH from 2012 to 2014 were analyzed retrospectively.The univariate analysis, multivariate Logistic analysis, ROC curve analysis and other statistical methods were used to study the predicting value of morning plasma ACTH and 24 h UFC in 3 days post operation.Results Univariate analysis showed that in the two groups of the early remission and no remission, there was significant statistical difference between the preoperative ACTH, preoperative 24 h UFC, postoperative ACTH and postoperative 24 h UFC （P〈0.05, 〈0.01, 〈0.01）. Logistic analysis showed that ACTH and 24 h UFC after operation of two groups had significant difference （P〈0.01, 〈0.05）. ROC curve analysis showed that postoperative cutoff values of ACTH and 24 h UFC were 4.11 pmol/L （18.7 pg/ml） and 281.42 nmol （102 μg）/24 h. ROC analysis was performed to evaluate the predicting performance of postoperative ACTH, resulting in an area under the curve （AUC） of 0.917 （95%CI： 0.858-0.957, P〈0.01）. In comparison, 24 h UFC had an AUC of 0.814 （95%CI： 0.739-0.875, P〈0.01）. The predicting value of ACTH is significantly better than that of 24 h UFC （P=0.005）.Conclusion Early morning 24 h UFC and ACTH within 3 days after operation both showed considerable accuracy in predicting the long-term outcome of Cushing′s disease, and the significance of ACTH was even greater than that of 24 h UFC.