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目的分析大剂量地塞米松抑制试验(high-dose dexamethasone suppression test,HDDST)不可抑制的库欣病患者临床和生化特点。方法回顾性分析1991至2006年我院经手术病理证实为垂体ACTH腺瘤的库欣病患者60例,根据HDDST(2 mg/次,每6 h 1次,连用48 h)结果将患者分为抑制组(抑制≥50%)和不可抑制组,比较两组间临床和生化指标差异。结果(1)23.3%的患者(14/60)HDDST不可抑制,抑制组和不可抑制组的平均年龄[(33.8±10.4 vs 36.2±11.2)岁]和平均病程[(2.1±1.6 vs 3.9±3.1)年]相近(P>0.05)。(2)临床症状:与抑制组比较,不可抑制组双下肢浮肿(64.3% vs 32.6%)、低血钾(71.4% vs 28.3%)、继发性糖尿病(57.1% vs 26.1%)和皮肤紫纹的发生率(85.7% vs 54.3%)明显增高(均P<0.05);两组的高血压、中心性肥胖、色素沉着等症状的发生率相仿(均P>0.05)。(3)激素水平:不可抑制组8:00的血ACTH[(31.7±17.8 vs 17.6±11.6)pmol/L]、皮质醇[(1144.3±354.1 vs 696.1±207.9)nmol/L]和24 h尿游离皮质醇[UFC(2760.3±1851.0 vs 1208.0±690.0)nmol/24h]较抑制组明显增高(均P<0.01);而两组午夜(0:00)血ACTH和皮质醇水平相似(均P>0.05)。(4)生化检查:不可抑制组的血钾更低[(3.2±0.7 vs 3.8±0.6)mmol/L],二氧化碳结合力更高[(29.3±3.6 vs 26.6±3.6)mmol/L](均P<0.01)。结论HDDST不可抑制的库欣病患者8:00的血ACTH、皮质醇和24 h UFC水平增高更明显,容易出现下肢浮肿、皮肤紫纹、高血糖和低血钾,代谢性碱中毒的程度也更严重。
Objective To analyze the clinical and biochemical characteristics of patients with Cushing’s disease that can not be suppressed by high-dose dexamethasone suppression test (HDDST). Methods A retrospective analysis of 60 patients with Cushing’s disease confirmed by histopathology in our hospital from 1991 to 2006 was classified into three groups according to the results of HDDST (2 mg / time, once every 6 hours, once every 48 hours) Inhibition group (≥50% inhibition) and non-suppression group, the differences of clinical and biochemical indexes between the two groups were compared. RESULTS: (1) 23.3% of patients (14/60) had no inhibition of HDDST, and mean age [(33.8 ± 10.4 vs 36.2 ± 11.2) years] and mean duration of [2.1 ± 1.6 vs 3.9 ± 3.1 ) Years] (P> 0.05). (2) Clinical symptoms: The edema of both lower extremities (64.3% vs 32.6%), hypokalemia (71.4% vs 28.3%), secondary diabetes (57.1% vs 26.1%) and skin purple (85.7% vs 54.3%, P <0.05). The prevalence of hypertension, central obesity, hyperpigmentation and other symptoms were similar in both groups (all P> 0.05). (3) Hormone levels: The blood ACTH [(31.7 ± 17.8 vs 17.6 ± 11.6) pmol / L], cortisol [(1144.3 ± 354.1 vs 696.1 ± 207.9) nmol / L] The levels of free Cortisol (UFC (2760.3 ± 1851.0 vs 1208.0 ± 690.0 nmol / 24h were significantly higher than those in the control group (P <0.01) 0.05). (4) Biochemical tests showed that the non-inhibitory group had lower serum potassium (3.2 ± 0.7 vs 3.8 ± 0.6) mmol / L and higher carbon dioxide binding (29.3 ± 3.6 vs 26.6 ± 3.6 mmol / L) P <0.01). CONCLUSIONS: Cushing’s disease, which can not be suppressed by HDDST, increased blood ACTH, Cortisol and 24-h UFC levels more significantly at 8:00 am, and was more prone to lower extremity edema, purplish skin, hyperglycemia and hypokalemia, and more to metabolic alkalosis serious.