Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China.
J Clin Endocrinol Metab. 2021 Jan 1;106(1):e94-e102. doi: 10.1210/clinem/dgaa773.
Recurrence of Cushing disease (CD) can occur even decades after surgery. Biomarkers to predict recurrence of CD after surgery have been studied but are inconclusive.
The aim of our study was to identify specific biomarkers that can predict long-term remission after neurosurgery.
Identification of specific biomarkers to predict long-term remission of CD was performed by logistic regression analysis followed by Kaplan-Meier survival analysis, using recurrence as the dependent variable.
A total of 260 patients with CD identified from our institutional research patient data registry search tool and from patients who presented to our longitudinal multidisciplinary clinic between May 2008 and May 2018 underwent statistical analysis.
Data on clinical features, neuro-imaging study, pathology, biochemistry, and treatments were collected by reviewing digital chart records.
Postoperative cortisol as a biomarker to predict long-term remission after surgical treatment for CD.
By logistic regression analysis, postoperative day 1 (POD1) morning (5-10 am) serum cortisol, female sex, and proliferative index had significant association with CD recurrence (odds ratio [OR] = 1.025, 95% CI: 1.002-1.048, P = .032). In contrast, the postoperative nadir cortisol (OR = 1.081, 95% CI: 0.989-1.181, P = .086), urinary free cortisol (OR = 1.032, 95% CI: 0.994-1.07, P = .098), and late night salivary cortisol (OR = 1.383, 95% CI: 0.841-2.274, P = .201) had no significant correlation with recurrence. A significant association between POD1 morning serum cortisol and long-term CD remission was verified by Kaplan-Meier analysis when using POD1 morning serum cortisol <5 μg/dL as the cut-off.
The POD1 morning serum cortisol level has a significant association with CD recurrence.
即使在手术后几十年，库欣病（CD）也可能复发。已经研究了预测手术后 CD 复发的生物标志物，但结果尚无定论。
本研究的目的是确定可以预测神经外科手术后长期缓解的特定生物标志物。
通过逻辑回归分析确定预测 CD 长期缓解的特定生物标志物，然后使用复发作为因变量进行 Kaplan-Meier 生存分析。
对 2008 年 5 月至 2018 年 5 月期间从我们的机构研究患者数据登记搜索工具和我们的纵向多学科诊所就诊的 CD 患者进行了回顾性分析，共纳入 260 例 CD 患者。
通过查阅电子病历收集临床特征、神经影像学研究、病理、生物化学和治疗数据。
术后第 1 天（POD1）早晨（5-10 点）血清皮质醇作为预测 CD 手术后长期缓解的生物标志物。
通过逻辑回归分析，术后第 1 天（POD1）早晨（5-10 点）血清皮质醇、女性和增殖指数与 CD 复发有显著关联（比值比[OR] = 1.025，95%置信区间：1.002-1.048，P = 0.032）。相反，术后最低皮质醇（OR = 1.081，95%置信区间：0.989-1.181，P = 0.086）、尿游离皮质醇（OR = 1.032，95%置信区间：0.994-1.07，P = 0.098）和午夜唾液皮质醇（OR = 1.383，95%置信区间：0.841-2.274，P = 0.201）与复发无显著相关性。Kaplan-Meier 分析显示，当以 POD1 早晨血清皮质醇<5μg/dL 为截断值时，POD1 早晨血清皮质醇与 CD 长期缓解有显著相关性。
POD1 早晨血清皮质醇水平与 CD 复发有显著相关性。
