不同类型的促肾上腺皮质激素依赖性库欣综合征患者凝血功能临床特点

Clinical Characteristic of Coagulation Function in Patients with Different Types of Adrencorticotropic Hormone-Dependent Cushing Syndrome

目的探讨不同类型的促肾上腺皮质激素(ACTH)依赖性库欣综合征患者的凝血功能临床特点。方法回顾性分析2014年6月至2021年5月在郑州大学第一附属医院确诊的72例ACTH依赖性库欣综合征患者,其中库欣病(CD)患者56例,异位ACTH综合征(EAS)患者16例,比较两组患者间的凝血功能相关指标和激素水平的差异;选择两组24 h尿游离皮质醇(24 h UFC)1000~2000 nmol的患者,比较其激素及凝血功能相关指标的差异。对所有患者的凝血功能相关指标与激素水平及年龄、病程、体质量指数(BMI)、血糖、血压等指标进行相关性分析。结果CD组不同时间血ACTH、皮质醇、24 h UFC水平及凝血酶时间和D二聚体水平均低于EAS组(P<0.05),活化部分凝血活酶时间(APTT)和纤维蛋白原高于EAS组(P<0.05);两组24 h UFC 1000~2000 nmol患者比较,CD组纤维蛋白原高于EAS组(P<0.05),凝血酶时间和D-二聚体均低于EAS组(P<0.05)。ACTH依赖性库欣综合征患者APTT与血ACTH(早8点)、24 h UFC、年龄和血糖均呈负相关;纤维蛋白原与24 h UFC呈负相关;D-二聚体与血皮质醇(早8点)、24 h UFC、年龄呈正相关;凝血酶时间与血ACTH、24 h UFC、血糖呈正相关,与病程呈负相关。结论ACTH依赖性库欣综合征的血液高凝状态主要表现在APTT的缩短和D-二聚体的升高,APTT的缩短主要与高ACTH和皮质醇有关,而D-二聚体升高不仅与高皮质醇相关,还与恶性肿瘤本身相关。EAS较CD更易出现高凝状态。

Objective To discuss the clinical characteristics of coagulation function in patients with different types of adrenocorticotropic hormone(ACTH)-dependent Cushing syndrome.Methods A total of 72 patients with ACTH-dependent Cushing syndrome admitted to the Department of Endocrinology of the First Affiliated Hospital of Zhengzhou University from June 2014 to May 2021,including 56 patients with Cushing disease(CD)and 16 patients with ectopic ACTH syndrome(EAS),were retrospectively analyzed.The differences of coagulation function related indicators and hormone levels were compared between the two groups.Two groups of patients with 24-hour urinary free cortisol(24 h UFC)between 1000~2000 nmol were selected,and the hormone level and coagulation function indexes were analyzed.The correlation analysis of hormones,age,disease duration,body mass index(BMI),glucose,blood pressure and coagulation function were conducted.Results The levels of ACTH,cortisol,24 h UFC,thrombin time and D-dimer in CD group were lower than those in EAS group(P<0.05),and the levels of activated partial thromboplastin time(APTT)and fibrinogen in CD group were higher than those of EAS group(P<0.05).In the patients with 24 h UFC between 1000~2000 nmol,the level of fibrinogen in CD group was higher than that in EAS group(P<0.05),the levels of thrombin time and D-dimer in CD group were lower than those in EAS group(P<0.05).In ACTH-dependent Cushing syndrome patients,APTT was negatively correlated with ACTH(8:00 am),24 h UFC,age and glucose.Fibrinogen was negatively correlated with 24 h UFC.D-dimer was positively correlated with cortisol(8:00 am),24 h UFC and age.Thrombin time was positively correlated with ACTH,24 h UFC and glucose,and negatively correlated with disease duration.Conclusion The hypercoagulability state of ACTH-dependent Cushing syndrome is mainly manifested in the shortening of APTT and the increase of D-dimer.The shortening of APTT is mainly related to high ACTH and cortisol,while the increase of D-dimer is not only related to high cortisol but also associated with malignant tumor itself.Hypercoagulability is more likely to occur in EAS than that in CD.