非ACTH依赖性库欣综合征合并心功能不全患者的临床特点分析

Analysis of clinical characteristics of patients with ACTH-independent Cushing′s syndrome complicated with cardiac insufficiency

目的总结非促肾上腺皮质激素(ACTH)依赖性库欣综合征(CS)合并心功能不全患者的临床特点,为在非ACTH依赖性CS患者中更好地识别出心功能不全的高危人群提供理论依据。方法收集以"非ACTH依赖性CS"为检索词,在北京大学第一医院住院电子病例系统中检索2014年1月至2019年3月出院诊断为非ACTH依赖性CS的病例资料。根据患者心功能情况分为两组:心功能不全组及对照组。比较两组患者的临床特点。结果心功能不全组与对照组相比,左室射血分数显著降低[(61.50±11.07)%比(70.61±5.67)%,P=0.005],室间隔厚度及左室后壁厚度均显著升高,血清皮质醇节律和24 h尿皮质醇均显著升高,服用降压药种类更多,糖化血红蛋白水平更高。室间隔厚度与血清皮质醇的曲线下面积呈显著正相关(r=0.370,P<0.001),左室后壁厚度与血清皮质醇的曲线下面积呈显著正相关(r=0.257,P=0.003)。Logistic回归分析显示,发生心功能不全的独立危险因素包括低钾血症病史、血清皮质醇曲线下面积大于335.36(μg/dl)·h、左室射血分数小于60%、左室后壁厚度大于1.1 cm(P均<0.05)。结论非ACTH依赖性CS合并心功能不全患者的主要表现为室间隔和左室后壁增厚、左室射血分数轻度下降、更难控制的高血糖和高血压。发生心功能不全的危险因素包括低钾血症病史、严重升高的皮质醇水平、左室射血分数降低及左室后壁增厚。

Objective The clinical characteristics of patients with adrenocorticotropic hormone(ACTH)independent Cushing′s syndrome(CS)complicated with cardiac insufficiency were summarized and analyzed,in order to provide a better identification for high risk populations of heart dysfunction in patients with ACTH independent CS.Methods The patients diagnosed with ACTH independent CS were searched from the electronic medical records system of Peking University First Hospital on discharge from January 2014 to March 2019.These patients were divided into two groups:cardiac insufficiency group and control group.The clinical features of two groups were compared.Results Compared to control group,patients in cardiac insufficiency group had significantly decreased left ventricular ejection fraction(LVEF)[(61.50±11.07)%vs.(70.61±5.67)%,P=0.005],thicker interventricular septum and left ventricular posterior wall,higher levels of serum cortisol rhythm,24-hour urine free cortisol and glycosylated hemoglobin A1c,as well as more antihypertensive drugs.Thickness of interventricular septum was positively associated with area under curve of serum cortisol rhythm(r=0.370,P<0.001).Thickness of left ventricular posterior wall was also positively associated with area under curve of serum cortisol rhythm(r=0.257,P=0.003).The risk factors of cardiac insufficiency for patients with ACTH independent CS included a hypokalemia history,area under curve of serum cortisol rhythm more than 335.36(μg/dl)·h,LVEF less than 60%,and thickness of left ventricular posterior wall more than 1.1 cm in CS(all P<0.05).Conclusions The main clinical manifestations of ACTH independent CS with cardiac insufficiency are thicker interventricular septum and left ventricular posterior wall,decreased LVEF,more difficult control of hyperglycemia and hypertention.Patients with a hypokalemia history,higher level of serum cortisol,decreased LVEF and thicker left ventricular posterior wall will more likely to complicate with cardiac insufficiency.