亚临床库欣综合征皮质醇水平与肾上腺影像学指标的相关性分析

Correlation between cortisol levels and adrenal imaging indicators in subclinical Cushing’s syndrome

目的探讨不同皮质醇水平的亚临床库欣综合征(SCS)患者肾上腺影像学指标的差异,并分析相关的影响因素。方法回顾性分析2010年1月-2020年1月解放军总医院第一医学中心内分泌科收治的65例SCS患者的临床资料。以午夜1 mg地塞米松抑制试验后晨8:00时血皮质醇(1 mg DST-F_(8:00))138 nmol/L为切点分为低水平组(n=36)与高水平组(n=29),比较两组患者的临床特点、生化指标、血促肾上腺皮质激素-皮质醇(ACTH-F)水平、肿瘤大小、CT值及对侧肾上腺影像学特点。采用logistic回归分析两组患者对侧肾上腺宽度与相关因素的关系;多因素线性回归分析对侧肾上腺长度、宽度、高度与不同代谢指标的关系。结果两组患者的病程、体重指数(BMI)、血压、血糖、血脂、骨密度、合并相关代谢异常等差异无统计学意义,但高水平组患者年龄及发病年龄更小(P<0.001),且女性较多(P=0.014);高水平组午夜0:00时皮质醇水平(F_(0:00))及1 mg DST-F_(8:00)较低水平组明显升高(P<0.001);两组患者的肿瘤大小、CT值及对侧肾上腺的长度、高度、体积均无明显差异,但高水平组对侧肾上腺宽度小于低水平组(P=0.007)。SCS患者1 mg DST-F_(8:00)升高水平与对侧肾上腺宽度呈明显负相关(β=-1.79,95%CI-3.05~-0.52,P=0.007);以性别、年龄、发病年龄、病程、BMI、ACTH水平、肿瘤直径为调整变量逐一行logistic回归分析两组SCS患者1 mg DST-F_(8:00)与对侧肾上腺宽度的关系,结果仍一致。多因素线性回归分析结果显示,对侧肾上腺宽度与舒张压呈明显负相关(β=-2.484,95%CI-3.883~-1.085,P=0.002),而对侧肾上腺长度及高度与代谢指标无明显相关性。结论1 mg DST-F_(8:00)水平更高的SCS患者对侧肾上腺宽度更小,且舒张压更高。

Objective To explore the differences of adrenal imaging indicators of patients with subclinical Cushing syndrome(SCS)and different cortisol levels,and analyze the related influencing factors.Methods Retrospectively analyze the clinical data of 65 patients with SCS admitted in the Department of Endocrinology of the First Medical Center of Chinese PLA General Hospital from January 2010 to January 2020.Subjects were undergone 1 mg dexamethasone suppression test(DST)at midnight,then with the blood cortisol level of 138 nmol/L at 8:00 am as a cut-off(1 mg DST-F_(8:00)),divided into low-level group(n=36)and high-level group(n=29).The clinical characteristics,biochemical indicators,adrenocorticotropic hormone-cortisol(ACTH-F),tumor size,CT value and contralateral adrenal gland image of the two groups were compared.The relationship of contralateral adrenal width to the related factors between the both groups were analyzed by logistic regression,and then multivariate linear regression analysis was performed to analyze the relationship of the contralateral adrenal length,width and height to the different metabolic indicators.Results No statistically significant difference in the course of disease,body mass index(BMI),blood pressure,blood glucose,blood lipid,bone density,and related metabolic abnormalities existed between the two groups.While the patients were significantly younger(P<0.001),the SCS onset time was much earlier(P<0.001),and the proportion of female patients was higher(P=0.014)in high-level group than those in low-level group.In addition,the cortisol level at midnight(F_(0.00))and 1 mg DST-F_(8:00)were obviously higher in high-level group than those in low-level group(P<0.001).No significant difference existed between the two groups in tumor size,CT value,contralateral adrenal gland length,height and volume,but the width was thinner in high-level group than those in low-level group(P=0.07).The level of 1 mg DST-F_(8:00)in SCS patients was negatively correlated with the width of contralateral adrenal gland(β=-1.79,95%CI-3.05--0.52,P=0.007).Using sex,age,age of onset,course of disease,BMI,ACTH level,and tumor diameter as adjustment variables,logistic regression was singularly performed to analyze the relationship between 1 mg DST-F_(8:00)and the width of contralateral adrenal gland in SCS patients,then the results were still consistent.Multivariate linear regression showed that the width of contralateral adrenal gland was negatively correlated with diastolic blood pressure(β=-2.484,95%CI-3.883--1.085,P=0.002),while the contralateral adrenal length and height showed no obvious correlations with the metabolic index.Conclusion SCS patients with higher level of 1 mg DST-F_(8:00)had thinner contralateral adrenal gland width and with higher diastolic blood pressure.