Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy.
Internal Medicine IStatistical UnitDepartment of Clinical and Biological Sciences, University of Turin, A.O.U. San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Italy
Eur J Endocrinol. 2014 Jul;171(1):127-36. doi: 10.1530/EJE-13-0555. Epub 2014 May 6.
Recent studies have questioned the reversibility of complications of Cushing's syndrome (CS) after successful surgical treatment. The aim of this study was to assess the outcome of patients with CS who achieved disease remission compared with those patients with persistent hypercortisolism and matched controls.
A retrospective study of 75 patients with CS followed at an academic center.
Cardiovascular risk profile was evaluated in 51 patients with CS in remission (group 1) and 24 patients with persistent disease (group 2) and compared with 60 controls. Mortality of patients with CS was compared with the background population.
In group 1, the frequency of cardiovascular risk factors dropped after disease remission even if it remained higher at the last follow-up than in the control group. In group 2, the frequency of cardiovascular risk factors remained unchanged during follow-up. The rate of cardiovascular and thromboembolic events was higher in group 2 than in group 1, as was the mortality rate (two deaths in group 1 and nine in group 2; ratio of two SMRs, 0.11; 95% CI, 0.011-0.512). Survival was significantly longer in group 1 than in group 2 (87 months, 80-98 vs 48 months, 38-62; P<0.0001).
Successful surgical treatment of hypercortisolism significantly improves cardiovascular risk and may reduce the mortality rate. Patients with persistent disease have increased morbidity and mortality when compared with patients in remission.
最近的研究对库欣综合征（CS）患者在成功接受手术治疗后并发症的可逆性提出了质疑。本研究旨在评估 CS 患者在达到疾病缓解与持续性高皮质醇血症患者和匹配对照组相比的结局。
对一个学术中心随访的 75 例 CS 患者进行回顾性研究。
评估了 51 例缓解（第 1 组）和 24 例持续性疾病（第 2 组）CS 患者的心血管风险特征，并与 60 例对照组进行比较。比较 CS 患者的死亡率与背景人群。
在第 1 组中，即使在最后一次随访时仍高于对照组，疾病缓解后心血管危险因素的频率也有所下降。在第 2 组中，在随访期间心血管危险因素的频率保持不变。第 2 组的心血管和血栓栓塞事件发生率以及死亡率均高于第 1 组（第 1 组有 2 例死亡，第 2 组有 9 例死亡；SMR 比值为 0.11；95%CI，0.011-0.512）。第 1 组的生存率明显长于第 2 组（87 个月，80-98 与 48 个月，38-62；P<0.0001）。
成功的皮质醇增多症手术治疗显著改善了心血管风险，可能降低死亡率。与缓解患者相比，持续性疾病患者的发病率和死亡率增加。
