肾上腺性库欣综合征患者中枢性甲状腺功能减退的发生与术后下丘脑-垂体-肾上腺轴恢复时项的相关性研究

To study the correlation between the occurrence of central hypothyroidism and the recovery time of hypothalamic-pituitary-adrenal axis in patients with adrenal Cushing's syndrome

目的探讨肾上腺性库欣综合征(ACS)患者发生中枢性甲状腺功能减退(简称中枢性甲减)的危险因素,评估其对术后下丘脑-垂体-肾上腺(HPA)轴恢复时项的影响。方法纳入腺瘤型ACS患者96例,根据是否发生中枢性甲减,将其分为中枢性甲减组(21例)和无中枢性甲减组(75例)。比较两组患者一般临床资料及实验室检查指标。采用Pearson相关分析评估ACS患者血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)和血清皮质醇8∶00、血清皮质醇24∶00、24 h尿游离皮质醇(24h UFC)及小剂量地塞米松抑制试验(LDDST)后血清皮质醇水平的相关性;采用二元logistic回归分析评估ACS患者发生中枢性甲减的独立危险因素。进一步评估两组患者术后HPA轴恢复情况。结果中枢性甲减组患者年龄、BMI、FT3及FT4水平均显著低于无中枢性甲减组,血清皮质醇8∶00、24h UFC及LDDST后血清皮质醇水平均显著高于无中枢性甲减组(P<0.05)。Pearson相关分析结果显示,ACS患者FT4及FT3水平与血清皮质醇8∶00、血清皮质醇24∶00、24h UFC及LDDST后血清皮质醇水平均呈负相关;TSH水平与血清皮质醇8∶00、血清皮质醇24∶00及LDDST后血清皮质醇水平均呈负相关(P<0.05)。多因素logistic回归分析结果显示,LDDST后血清皮质醇水平是ACS患者发生中枢性甲减的独立危险因素(P<0.05)。术后随访资料显示,中枢性甲减组患者术后3个月、12个月血浆促肾上腺皮质激素(ACTH)水平明显低于无中枢性甲减组(P<0.05),两组患者总体HPA轴恢复比例比较差异无统计学意义(P>0.05)。结论ACS患者伴随中枢性甲减的发生;术前是否合并中枢性甲减可作为ACS患者术后糖皮质激素替代治疗方案制定中的重要参考因素。

Objective To explore the risk factors of central hypothyroidism in patients with adrenal Cushing's syndrome(ACS),and evaluate its impact on the recovery time of the hypothalamic-pituitary-adrenal axis(HPA)axis after surgery.Methods Ninety-six patients with adenomatous ACS were enrolled and divided into central hypothyroidism group(21 cases)and non-central hypothyroidism group(75 cases)according to the presence or central hypothyroidism absence.General clinical data and laboratory examination indexes of the two groups were compared.Pearson correlation analysis was used to evaluate the correlation between thyroid-stimulating hormone(TSH),free triodothyronine(FT,),free thyroxine(FT4)and serum cortisol levels at 8:00,24:00,24h urinary free cortisol(24h UFC)and serum cortisol levels after low dose dexamethasone suppression test(LDDST)in ACS patients.Binary logistic regression analysis was used to evaluate the independent risk factors of central hypothyroidism in ACS patients,and the postoperative recovery of HPA axis of the two groups were further evaluated.Results Age,BMI,FT,and FT levels in central hypothyroidism group were significantly lower than those in non-central hypothyroidism group,and the serum cortisol levels at 8:00,24h UFC and after LDDST were significantly higher than those in noncentral hypothyroidism group(P<0.05).Pearson correlation analysis showed that FT4 and FT,levels were negatively correlated with serum cortisol 8:00,serum cortisol 24:00,24h UFC and serum cortisol after LDDST in ACS patients;TSH level was negatively correlated with serum cortisol 8:00,serum cortisol 24:00 and serum cortisol level after LDDST(P<0.05).Multivariate logistic regression analysis showed that serum cortisol level after LDDST was an independent risk factor for central hypothyroidism in ACS patients(P<0.05).The postoperative follow-up data showed that the plasma adrenocorticotropic hormone(ACTH)level in central hypothyroidism group was significantly lower than that in non-central hypothyroidism group at 3 and 12 months after surger(P<0.05),and there was no significant difference in the proportion of HPA axis recovery between the two groups(P>0.05).Conclusion1 ACS patients are accompanied by central hypothyroidism,which may be an important reference factor in determining therapy strategy of hydrocortisone replacement for patients with ACS.