肾上腺腺瘤型亚临床库欣综合征患者腺瘤切除术后肾上腺皮质功能减退影响因素及其预测效能
Influencing factors for adrenal insufficiency after adrenalectomy in patients with adrenal adenoma-type subclinical Cushing's syndrome and their predictive efficiency
田朝阳 1刘梦思 2楼媛 2曾阳杰 2王怡洁 1崇立业 1李平1
作者信息
- 1. 南京大学医学院附属鼓楼医院内分泌科,南京 210008
- 2. 中国医学科学院北京协和医学院研究生院;南京鼓楼医院内分泌科
- 折叠
摘要
目的 探讨肾上腺腺瘤型亚临床库欣综合征(SCS)患者腺瘤切除术后肾上腺皮质功能减退的影响因素,并分析相关影响因素对术后肾上腺皮质功能减退的预测效能.方法 选择59例肾上腺腺瘤型SCS患者,均行腹腔镜下单侧肾上腺腺瘤切除术,术后1个月根据血清皮质醇水平判断患者是否发生肾上腺皮质功能减退.比较肾上腺皮质功能减退患者与肾上腺皮质功能正常患者的术前一般资料[性别、年龄、身体质量指数(BMI)、入院时血压、代谢合并症(超重/肥胖、高血压、糖脂代谢异常、骨量减少/骨质疏松)、肿瘤直径]、术前肾上腺功能相关激素水平[促肾上腺皮质激素(ACTH)及皮质醇昼夜节律(8:00、24:00)、1 mg地塞米松抑制试验(1 mg-DST)后皮质醇、经典小剂量地塞米松抑制试验(LDDST)后皮质醇、血清硫酸脱氢表雄酮(DHEAS)以及24 h尿游离皮质醇(UFC)]以及术后糖皮质激素用药情况.以组间比较P<0.10的指标构建二元Logistic回归分析模型,分析SCS患者术后肾上腺皮质功能减退的影响因素,采用受试者工作特征(ROC)曲线评估相关指标的预测效能.结果 59例SCS患者中,术后1个月发生肾上腺皮质功能减退25例,发生率为42.37%.与肾上腺皮质功能正常患者比较,肾上腺皮质功能减退患者术前8:00血浆ACTH水平降低,24:00血清皮质醇水平和1 mg-DST后皮质醇水平升高.Logistic回归分析显示,术前1 mg-DST血清皮质醇是SCS患者术后发生肾上腺皮质功能减退的独立影响因素.术前1 mg-DST血清皮质醇≥233 nmol/L的SCS患者术后肾上腺皮质功能减退的相对风险比为13.698(95%CI为2.965～63.274).结论 SCS患者术后存在发生肾上腺皮质功能减退的风险,术前1 mg-DST血清皮质醇是术后肾上腺皮质功能减退的独立影响因素,对术后肾上腺皮质功能减退发生具有较好的预测效能.
Abstract
Objective To explore the influencing factors for adrenal insufficiency after adrenalectomy in patients with adrenal adenoma-type subclinical Cushing's syndrome(SCS)and to analyze the predictive efficacy of relevant influ-encing factors on postoperative adrenal insufficiency.Methods Fifty-nine patients with adrenal adenoma-type SCS un-derwent laparoscopic unilateral adrenalectomy.Adrenal insufficiency was assessed one month postoperatively based on se-rum cortisol levels.Preoperative general data[gender,age,body mass index(BMI),blood pressure,metabolic comorbid-ities(overweight/obesity,hypertension,abnormal glucose metabolism,dyslipidemia,osteopenia/osteoporosis),tumor di-ameter],preoperative adrenal function-related hormone levels[adrenocorticotropic hormone(ACTH)and cortisol diurnal rhythm(8:00,24:00),cortisol after 1 mg dexamethasone suppression test(1 mg-DST),cortisol after low-dose dexameth-asone suppression test(LDDST),serum dehydroepiandrosterone sulfate(DHEAS),and 24-hour urine free cortisol(UFC)],and postoperative glucocorticoid use were compared between patients with adrenal insufficiency and those with normal adrenal function.We constructed a binary Logistic regression analysis model using indicators with intergroup com-parison of P<0.10,analyzed the influencing factors of postoperative adrenal insufficiency in patients with SCS,and evalu-ated the predictive efficacy of relevant indicators by the receiver operating characteristic(ROC)curve.Results Adrenal insufficiency was observed in 25 out of 59 patients with SCS one month after surgery,accounting for 42.37%of these cas-es.Compared with patients with normal adrenal function,patients with adrenal insufficiency had decreased plasma ACTH levels at 8:00,and increased serum cortisol levels at 24:00 and after 1 mg-DST before surgery.Logistic regression analy-sis showed that preoperative serum cortisol after 1 mg-DST was an independent influencing factor for the development of ad-renal insufficiency in patients with SCS postoperatively.The relative risk ratio of adrenal insufficiency after surgery in SCS patients with preoperative 1 mg-DST serum cortisol≥233 nmol/L was 13.698(95%CI:2.965-63.274).Conclusions Patients with SCS are at risk of developing adrenal insufficiency after surgery.Preoperative serum cortisol after 1 mg-DST is an independent influencing factor for postoperative adrenal insufficiency and has good predictive efficacy on the occur-rence of adrenal insufficiency after surgery.
关键词
肾上腺腺瘤/亚临床库欣综合征/肾上腺腺瘤切除术后并发症/肾上腺皮质功能减退Key words
adrenal adenoma/subclinical Cushing's syndrome/complications after adrenalectomy/adrenal insuf-ficiency引用本文复制引用
基金项目
国家重点研发计划(2022YFC2505300)
国家重点研发计划(2022YFC2505306)
出版年
2024
国家科技期刊平台
NSTL
万方数据