双侧岩下窦取血对促肾上腺皮质激素微腺瘤术前诊断价值的研究

Value of bilateral inferior petrosal sinus sampling for preoperative diagnosis of adrenocorticotropic hormone microadenomas

目的探讨双侧岩下窦取血(bilateral inferior petrosal sinus sampling,BIPSS)对促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)微腺瘤术前诊断的价值。方法回顾性分析2013年10月—2017年5月接受术前BIPSS检查的ACTH微腺瘤患者的临床资料。按照ACTH值岩下窦/肘静脉血≥2和双侧岩下窦ACTH比值≥1.4的定性和定位标准,评价BIPSS对ACTH微腺瘤术前诊断的价值。结果共纳入5例患者,其中男1例,女4例;平均年龄(49.6±9.2)岁;平均病程(17.2±7.5)个月。全部5例患者ACTH值岩下窦/肘静脉血>2,3例在内镜下经鼻蝶入路垂体瘤切除术中发现肿瘤位置与BIPSS检查结果不符合。BIPSS术后有1例出现皮下血肿,1例出现短暂恶心,无颅内感染和死亡病例。结论 BIPSS对ACTH微腺瘤术前定性诊断有重要价值,但对微腺瘤在垂体组织中的定位诊断的价值不足。

Objective To explore the value of bilateral inferior petrosal sinus sampling（BIPSS） for preoperative diagnosis of adrenocorticotropic hormone（ACTH） microadenomas. Methods We retrospectively analyzed the clinical date of patients with ACTH microadenomas, who were experienced BIPSS preoperatively from October 2013 to May2017. The qualitative and localized diagnostic significance of BIPSS was evaluated based on the criteria of the plasma ACTH concentration ratio of inferior petrosal sinus to ulnar vein（≥2）, and the ratio of left to right inferior petrosal sinuses（≥1.4）. Results Five patients（1 male and 4 females） were involved in the study. The mean age was（49.6±9.2）years, and the mean disease course was（17.2±7.5） months. The plasma ACTH concentration of all the cases ran up to the criterition of the ratio of inferior petrosal sinus to ulnar vein（≥2）. Three cases were found that the actual locations of the microadenomas were inconsistent with the indications from the results of BIPSS. After the BIPSS procedure, there was no intracranial infection or death case, except that one patient suffered from ecchymoma and another one suffered from transient nausea. Conclusion BIPSS is valuable for qualitative diagnosis, but not effective for localization diagnosis of the ACTH microadenomas preoperatively.