用于诊断库欣综合征的单次午夜血浆皮质醇和 ACTH 的效用。
UTILITY OF A SINGLE LATE-NIGHT PLASMA CORTISOL AND ACTH FOR THE DIAGNOSIS OF CUSHING SYNDROME.
出版信息
Endocr Pract. 2018 Feb;24(2):156-162. doi: 10.4158/EP171803.OR. Epub 2017 Nov 16.
OBJECTIVE
To evaluate the diagnostic efficacy of various screening tests for the diagnosis of Cushing syndrome (CS).
METHODS
Thirty-five patients with CS and 16 patients of pseudo-CS were enrolled. Assessment of 24-h urinary free cortisol (UFC), late-night salivary cortisol (LNSC), overnight dexamethasone suppression test (ONDST), late-night plasma cortisol (LNPC), and adrenocorticotropic hormone (ACTH) on outpatient basis, and during sleep as well as in awake state after 48 hours of hospital admission.
RESULTS
We found that 24-h UFC performed the best among the screening tests with sensitivity, specificity and areas under the curve (AUCs) of 96.0%, 99%, and 0.988, respectively, at a cut-off of 144.6 μg/24 h. A cut-off of 10.5 nmol/L for LNSC had sensitivity 85.7%, specificity 88.2%, and an AUC of 0.897. A cut-off of 412.4 nmol/L for LNPC on outpatient basis had sensitivity 88.2%, specificity 91.2%, and an AUC of 0.957. Cut-offs of 215 and 243.3 nmol/L for LNPC during sleep and awake states after acclimatization had sensitivity, specificity, and an AUC of 94.1%, 88.2%, and 0.958, respectively. An ONDST cut-off of 94.6 nmol/L provided sensitivity, specificity, and an AUC of 96.0%, 99.03% and 0.995, respectively. A cut-off of 30.3 pg/mL for late-night ACTH on outpatient basis had sensitivity 67.6%, specificity 99.9%, and an AUC 0.796.A cut-off of 22.6 pg/mL for ACTH during sleep state after acclimatization had sensitivity, specificity, and an AUC of 73.5%, 99.2%, and 0.827, respectively.
CONCLUSION
UFC is the best screening test for CS. Furthermore, single measurements of LNPC and ACTH help to establish the diagnosis and ACTH dependency of CS in the majority of patients with CS.
ABBREVIATIONS
ACTH = adrenocorticotropic hormone AUC = area under the curve CRH = corticotropin-releasing hormone CS = Cushing syndrome ECLIA = electrochemiluminescence immuno-assay LDDST = low-dose dexamethasone suppression test LNPC = late-night plasma cortisol LNSC = late-night salivary cortisol ONDST = overnight dexamethasone suppression test RIA = radio-immuno assay UFC = urinary free cortisol.
目的
评估各种筛选试验对库欣综合征（CS）诊断的诊断效能。
方法
纳入 35 例 CS 患者和 16 例假性 CS 患者。评估 24 小时尿游离皮质醇（UFC）、夜间唾液皮质醇（LNSC）、过夜地塞米松抑制试验（ONDST）、夜间血浆皮质醇（LNPC）和促肾上腺皮质激素（ACTH），在门诊基础上，以及在入院后 48 小时的睡眠和清醒状态下。
结果
我们发现，24 小时 UFC 在筛选试验中表现最好，其截止值为 144.6μg/24h 时，灵敏度、特异性和曲线下面积（AUCs）分别为 96.0%、99%和 0.988。LNSC 的截止值为 10.5nmol/L 时，灵敏度为 85.7%，特异性为 88.2%，AUC 为 0.897。LNPC 门诊基础上的截止值为 412.4nmol/L 时，灵敏度为 88.2%，特异性为 91.2%，AUC 为 0.957。适应睡眠和清醒状态后的 LNPC 截止值为 215 和 243.3nmol/L 时，灵敏度、特异性和 AUC 分别为 94.1%、88.2%和 0.958。ONDST 的截止值为 94.6nmol/L 时，灵敏度、特异性和 AUC 分别为 96.0%、99.03%和 0.995。LNPC 门诊基础上的夜间 ACTH 截止值为 30.3pg/ml 时，灵敏度为 67.6%，特异性为 99.9%，AUC 为 0.796。适应睡眠状态后的夜间 ACTH 的截止值为 22.6pg/ml 时，灵敏度、特异性和 AUC 分别为 73.5%、99.2%和 0.827。
结论
UFC 是 CS 的最佳筛查试验。此外，LNPC 和 ACTH 的单次测量有助于在大多数 CS 患者中确立 CS 的诊断和 ACTH 依赖性。
缩写词
ACTH = 促肾上腺皮质激素 AUC = 曲线下面积 CRH = 促皮质素释放激素 CS = 库欣综合征 ECLIA = 电化学发光免疫分析 LDDST = 小剂量地塞米松抑制试验 LNPC = 夜间血浆皮质醇 LNSC = 夜间唾液皮质醇 ONDST = 过夜地塞米松抑制试验 RIA = 放射免疫测定 UFC = 尿游离皮质醇。
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