Sun Xiaolin, Feng Ming, Lu Lin, Zhao Zixuan, Bao Xinjie, Deng Kan, Yao Yong, Zhu Huijuan, Wang Renzhi
Department of Neurosurgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
School of Medicine, Tsinghua University, Beijing, China.
Front Endocrinol (Lausanne). 2021 Feb 9;11:600323. doi: 10.3389/fendo.2020.600323. eCollection 2020.
Dyslipidemia has been frequently reported and associated with increased cardiovascular risk in patients with Cushing's disease (CD). Few studies are available regarding the relationships between lipid abnormalities and other preoperative metabolic comorbidities in CD, and the data on alterations of the lipid profile after surgery is quite variable. We aimed to investigate the associations between hyperlipidemia and other baseline metabolic and hormonal parameters and the impact of surgical remission on lipid metabolism in patients with CD.
This retrospective study included 104 patients diagnosed with CD. Baseline hormonal and metabolic parameters were compared between the hyperlipidemia (HLP) group and non-hyperlipidemia (NLP) group, and their relationships with hyperlipidemia at diagnosis were evaluated. Alterations in lipid profiles after surgical remission of CD were evaluated in 65 patients with available follow-up data.
Upon baseline, logistic regression analysis showed that impaired glucose metabolism (IGM) (OR=4.68, 95%CI:1.38-15.91) and morning cortisol levels (per 10 μg/dl change) (OR=1.81, 95%CI:1.11-2.95) are both independent risk factors of preoperative occurrence of hyperlipidemia in patients with CD. The baseline triglyceride (TG) level was positively correlated with systolic blood pressure (SBP) (r=0.297, p=0.003). Lipid abnormalities had improvement but may persist after surgical remission, and the persisted hyperlipidemia is associated with higher baseline total cholesterol (TC) levels (r=0.505, p=0.033).
Persistence of post-surgery hyperlipidemia is associated with severe baseline lipid abnormalities. Surgical remission with concomitant control of impaired glucose metabolism at diagnosis may have significant implications for controlling hyperlipidemia and reducing cardiovascular risk in CD.
库欣病（CD）患者中血脂异常屡有报道，且与心血管风险增加相关。关于CD患者脂质异常与其他术前代谢合并症之间的关系，相关研究较少，且术后血脂谱变化的数据差异较大。我们旨在研究高脂血症与其他基线代谢和激素参数之间的关联，以及手术缓解对CD患者脂质代谢的影响。
这项回顾性研究纳入了104例诊断为CD的患者。比较高脂血症（HLP）组和非高脂血症（NLP）组的基线激素和代谢参数，并评估它们与诊断时高脂血症的关系。对65例有可用随访数据的患者评估CD手术缓解后血脂谱的变化。
在基线时，逻辑回归分析显示，糖代谢受损（IGM）（OR = 4.68，95%CI：1.38 - 15.91）和早晨皮质醇水平（每变化10μg/dl）（OR = 1.81，95%CI：1.11 - 2.95）均为CD患者术前发生高脂血症的独立危险因素。基线甘油三酯（TG）水平与收缩压（SBP）呈正相关（r = 0.297，p = 0.003）。脂质异常在手术缓解后有所改善，但可能持续存在，持续的高脂血症与较高的基线总胆固醇（TC）水平相关（r = 0.505，p = 0.033）。
术后高脂血症的持续存在与严重的基线脂质异常有关。手术缓解并同时控制诊断时的糖代谢受损可能对控制CD患者的高脂血症和降低心血管风险具有重要意义。
