Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark.
Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark Departments of EndocrinologyClinical EpidemiologyLeiden University Medical Centre, Leiden 2300RC, The NetherlandsDepartment of EndocrinologyAarhus University, 8000 Aarhus C, DenmarkDepartment of Clinical EpidemiologyAarhus University, Aarhus, Denmark
Eur J Endocrinol. 2015 Apr;172(4):R143-9. doi: 10.1530/EJE-14-0556.
The aim of this systematic review and meta-analysis was to investigate whether mortality is increased in patients biochemically cured after initial treatment for Cushing's disease. This is a systematic review and meta-analysis of follow-up studies in patients cured from Cushing's disease after initial treatment was performed. Eight electronic databases were searched from 1975 to March 2014 to identify potentially relevant articles. Original articles reporting the standardized mortality ratio (SMR) for patients cured of Cushing's disease were eligible for inclusion. SMRs were pooled in a random effects model. I(2) statistics was used for quantification of heterogeneity. Eight cohort studies with a total of 766 patients were included. Out of eight studies, seven showed an SMR above 1.0 for cured patients. The pooled SMR was 2.5 (95% CI 1.4-4.2). The I(2) statistics showed evidence for statistical heterogeneity (78%, Q-statistics P<0.001), which was largely explained by two outliers. This meta-analysis reveals that mortality remains increased in patients with Cushing's disease even after initial biochemical cure remission, suggesting that cure does not directly reverse the metabolic consequences of long-term overexposure to cortisol. Other conditions such as hypopituitarism, including persistent adrenocortical insufficiency after surgery, may also contribute to the increased mortality risk.
本系统评价和荟萃分析的目的在于调查在库欣病初始治疗后生化治愈的患者死亡率是否增加。这是一项对库欣病初始治疗后治愈患者进行随访研究的系统评价和荟萃分析。从 1975 年至 2014 年 3 月，我们在 8 个电子数据库中搜索了可能相关的文章。纳入了报道库欣病患者治愈后标准化死亡率（SMR）的原始文章。SMR 采用随机效应模型进行汇总。采用 I²统计量来量化异质性。共有 766 例患者的 8 项队列研究符合纳入标准。在这 8 项研究中，有 7 项研究显示治愈患者的 SMR 高于 1.0。汇总的 SMR 为 2.5（95%CI 1.4-4.2）。I²统计量显示存在统计学异质性（78%，Q 统计量 P<0.001），这主要由两个离群值解释。这项荟萃分析表明，即使在初始生化治愈缓解后，库欣病患者的死亡率仍然升高，这表明治愈并不能直接逆转长期皮质醇过度暴露的代谢后果。其他情况，如垂体功能减退症，包括手术后持续的肾上腺皮质功能不全，也可能导致死亡率风险增加。
