Objective To clarify the improvement of postoperative metabolic complications in patients with subclinical Cushing's syndrome(SCS),explore the factors predict postoperative metabolic benefits in SCS patients.Methods A total of 144 patients diagnosed with adrenal adenoma-type SCS were retrospectively enrolled.According to whether received surgery or not,they were divided into surgery group(97 cases)and non-surgery group(47 cases).According to different metabolic outcomes,65 patients in surgery group with metabolic comorbidities before surgery were divided into metabolic improvement group(44 cases)and metabolic non-improvement group(21 cases).General clinical data and CT examination results of all patients were collected and compared in groups.Logistic regression analysis was used to evaluate the influencing factors of preoperative indicators on postoperative metabolic benefits of SCS,and the regression equation was obtained to construct a nomogram scoring model.The calibration chart and goodness of fit were used to test the calibration efficiency.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the model and related indicators.Results Adrenal tumor diameter,1 mg dexamethasone suppression test(DST)cortisol,2 mg-DST cortisol,the proportion of female and patients with abnormal lipid metabolism in surgery group were significantly higher than those in non-surgical group,and the plasma ACTH and serum DHEAS level at 8:00 were significantly lower than those in non-surgery group(P＜0.05).Preoperative adrenal tumor diameter,1 mg-DST cortisol level,the proportion of patients with preoperative hypertension and two or more metabolic comorbidities in metabolism improved group were significantly higher than those in metabolism no-improved group(P＜0.05).Multivariate logistic regression analysis showed that adrenal tumor diameter,l mg-DST cortisol,and two or more metabolic comorbidities were independent factors influencing the metabolic improvement of SCS after surgery(P＜0.05).The area under the ROC curve of the nomogram scoring model to predict the metabolic improvement of SCS was 0.871,the sensitivity was 75.0％and the specificity was 90.5％,which was better than the prediction value of each index alone.Conclusion There is heterogeneity in the metabolic outcomes of SCS patients after surgical treatment.The nomogram scoring model combined with adrenal tumor diameter,l mg-DST cortisol and whether there are two or more metabolic comorbidities can be used to predict the probability of postoperative metabolic improvement.
维普
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