Pedersen A G, Hansen M, Hummer L, Rogowski P
Cancer. 1985 Nov 15;56(10):2476-80. doi: 10.1002/1097-0142(19851115)56:10<2476::aid-cncr2820561024>3.0.co;2-q.
Adrenocorticotrophic hormone (ACTH) concentrations were measured in the plasma and cerebrospinal fluid (CSF) of 107 consecutive patients with known or suspected central nervous system (CNS) metastases secondary to small cell carcinoma of the lung. The combined results of computerized tomography scans, neurologic examination, and autopsy were used to determine the presence or absence of CNS metastases. On the basis of such an assessment, definitive conclusions were possible in 77 patients. CNS metastases were present in 52 cases and absent in 25. The median CSF ACTH level was 30 ng/ml in both groups. None of five patients with very high CSF ACTH concentrations had elevated ACTH concentrations in plasma. Considering the 95th percentile of patients without CNS metastases as the upper limit of normal, 12 patients with metastases and one without had an elevated CSF ACTH value. Eleven patients with leptomeningeal carcinomatosis (MC) did not constitute a special subgroup in this respect. The median ratio of CSF ACTH and plasma ACTH was 1.0 in patients with CNS metastases and 0.4 in those without (P less than 0.05). Patients with MC had a median ratio of 1.3, which was significantly different from that of both of the other groups (P less than 0.05). Ten patients with CNS metastases (one with MC) and one without exceeded the upper 95th percentile of the CSF/plasma (ACTH) ratio in patients without CNS metastases. The significance levels of these findings disappeared, however, when patients with signs of an elevated ACTH concentration in plasma were excluded. Patients with ectopic ACTH production into CSF do not necessarily have ectopic ACTH production outside the CNS, despite the presence of extracerebral metastases. With the criteria employed in this study, an elevated level of CSF ACTH diagnosed too few patients for the authors to recommend its determination as a single test in diagnosing CNS metastases or MC secondary to small cell carcinoma of the lung.
对107例连续的已知或疑似继发于肺小细胞癌的中枢神经系统（CNS）转移患者的血浆和脑脊液（CSF）中的促肾上腺皮质激素（ACTH）浓度进行了测量。计算机断层扫描、神经系统检查和尸检的综合结果用于确定是否存在CNS转移。基于这样的评估，77例患者得出了明确的结论。52例存在CNS转移，25例不存在。两组患者的CSF ACTH水平中位数均为30 ng/ml。5例CSF ACTH浓度非常高的患者血浆中ACTH浓度均未升高。将无CNS转移患者的第95百分位数作为正常上限，12例有转移的患者和1例无转移的患者CSF ACTH值升高。11例柔脑膜癌病（MC）患者在这方面并未构成一个特殊亚组。有CNS转移患者的CSF ACTH与血浆ACTH的中位数比值为1.0，无转移患者为0.4（P<0.05）。MC患者的中位数比值为1.3，与其他两组均有显著差异（P<0.05）。10例有CNS转移的患者（1例为MC）和1例无转移的患者超过了无CNS转移患者CSF/血浆（ACTH）比值的第95百分位数上限。然而，当排除血浆ACTH浓度升高迹象的患者时，这些发现的显著性水平消失了。尽管存在脑外转移，但CSF中产生异位ACTH的患者不一定在CNS外产生异位ACTH。根据本研究采用的标准，CSF ACTH水平升高诊断出的患者太少，作者无法推荐将其测定作为诊断继发于肺小细胞癌的CNS转移或MC的单一检测方法。
