Barahona María-José, Resmini Eugenia, Viladés David, Fernández-Real José-Manuel, Ricart Wifredo, Moreno-Navarrete José-María, Pons-Lladó Guillem, Leta Rubén, Webb Susan M
Department of Endocrinology, Hospital Universitari Mútua de Terrassa, Pl Dr Robert 5, 08221, Terrassa, Barcelona, Spain,
Pituitary. 2015 Feb;18(1):135-41. doi: 10.1007/s11102-014-0566-9.
Increased cardiovascular (CV) risk persists in Cushing's syndrome (CS), despite remission of hypercortisolism. The aim of this study was to evaluate prevalence of coronary artery disease in CS patients and its correlation with classical CV risk factors and inflammatory markers.
Cardiac multidetector computed tomography (MDCT) was performed in 41 patients (7 men, 31 of pituitary origin, 29 cured, mean age: 48.6 ± 13 years), using 64-slice Toshiba Aquilion systems. Coronary atherosclerotic plaques were detected and coronary calcifications quantified by the Agatston score (AS). Clinical and biochemical parameters were correlated with the AS to identify possible surrogate markers of coronary disease. Normal values for clinical and biochemical parameters were obtained from a gender- and age-matched normal reference population (n = 82).
CS patients with calcifications (AS > 0) (N = 13, 32%) had higher levels of sTNF-R1, homocysteine, triglycerides, blood pressure and body mass index than patients without calcifications (AS = 0) and those of normal reference population. Both groups of CS patients (AS > 0 and AS = 0) had elevated trunk fat mass and IL-6 compared to reference values. Patients with AS > 0 had less adiponectin and higher insulin, HOMA and fibrinogen than those found in normal reference population. sTNF-R1 correlated positively with AS and remained significant after adjusting for confounding factors. The same result was observed when we considered only cured CS patients.
In our cohort of CS patients sTNF-R1 was a predictor of coronary calcifications. Since MDCT is an expensive technique not readily available in daily clinical practice, increased sTNF-R1 could be a marker of CV risk even in cured CS.
尽管皮质醇增多症已缓解，但库欣综合征（CS）患者心血管（CV）风险仍持续存在。本研究旨在评估CS患者冠状动脉疾病的患病率及其与经典CV危险因素和炎症标志物的相关性。
使用64层东芝Aquilion系统对41例患者（7例男性，31例垂体源性，29例已治愈，平均年龄：48.6±13岁）进行心脏多排螺旋CT（MDCT）检查。检测冠状动脉粥样硬化斑块并通过阿加斯顿评分（AS）对冠状动脉钙化进行量化。将临床和生化参数与AS相关联，以确定冠状动脉疾病可能的替代标志物。临床和生化参数的正常数值来自性别和年龄匹配的正常参考人群（n = 82）。
有钙化（AS>0）的CS患者（N = 13，32%）的可溶性肿瘤坏死因子受体1（sTNF-R1）、同型半胱氨酸、甘油三酯、血压和体重指数水平高于无钙化（AS = 0）的患者以及正常参考人群。两组CS患者（AS>0和AS = 0）的躯干脂肪量和白细胞介素-6（IL-6）均高于参考值。AS>0的患者脂联素水平较低，胰岛素、稳态模型评估胰岛素抵抗指数（HOMA）和纤维蛋白原水平高于正常参考人群。sTNF-R1与AS呈正相关，在调整混杂因素后仍具有显著性。仅考虑已治愈的CS患者时也观察到相同结果。
在我们的CS患者队列中，sTNF-R1是冠状动脉钙化 的一个预测指标。由于MDCT是一种昂贵的技术，在日常临床实践中不易获得，即使在已治愈的CS患者中，sTNF-R1升高也可能是CV风险的一个标志物。
