Department of Neurological Surgery, University of Miami, Miami, FL, USA.
Department of Neurological Surgery, University of Miami, Miami, FL, USA.
Clin Neurol Neurosurg. 2022 Sep;220:107350. doi: 10.1016/j.clineuro.2022.107350. Epub 2022 Jun 24.
Inferior petrosal sinus sampling (IPSS) offers a means of differentiating between Cushing disease and Cushing syndrome with lower false-positive and false-negative rates relative to traditional techniques. However, consolidated data on efficiency reflecting contemporary use is lacking. We present a comprehensive meta-analysis of IPSS as a means of diagnosing ACTH-cortisol axis derangements via both CRH and desmopressin-stimulated techniques.
Searches of 7 electronic databases from inception to December 2020 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Outcomes were pooled by random-effects meta-analyses of proportions where possible. We performed a meta-analysis of sixty-eight unique publications, assessing each technique for positive predictive value (PPV), false positive rates, and overall changes in practice patterns over time.
A total of 68 studies satisfied all criteria, with 3685 (3471, 94.2% confirmed) and 332 (285, 85.8% confirmed) patients tested for Cushing's disease and syndrome, respectively. Pooled analyses demonstrated an overall PPV of 89.3% (95%CI[83.6%, 94.0%]) in CRH stimulation diagnosis of Cushing disease. In desmopressin stimulation, our analyses demonstrated an overall PPV of 96.5% (95%CI[94.5%, 98.1%]) in diagnosis of Cushing disease. There was a significant decline in the use of CRH-stimulation IPSS in diagnosis of both Cushing disease (p = 0.0055) and Cushing syndrome (p = 0.013). Concurrently, there was a significant increase in the use of desmopressin-stimulation IPSS in diagnosis of both pathologies (p < 0.0001).
Our findings demonstrate significant changes in practice patterns with respect to IPSS stimulation technique. Our pooled analyses demonstrate improved diagnostic performance in desmopressin stimulation procedures relative to CRH stimulation procedures. Further multi-institutional studies with special attention to acquiring quality data for sensitivity, specificity, and other critical analyses are necessary to truly evaluate this promising technique.
相较于传统技术，岩下窦采血（IPSS）可提供一种鉴别库欣病和库欣综合征的方法，假阳性和假阴性率更低。然而，目前缺乏反映当代应用的效率的综合数据。我们进行了岩下窦采血（通过 CRH 和去氨加压素刺激技术）诊断 ACTH-皮质醇轴紊乱的综合荟萃分析。
根据 PRISMA 指南，对从成立到 2020 年 12 月的 7 个电子数据库进行了搜索。根据预先指定的标准筛选文章。如果可能，通过随机效应荟萃分析对比例进行汇总。我们对 68 项独特的出版物进行了荟萃分析，评估了每种技术的阳性预测值（PPV）、假阳性率以及随时间推移的实践模式的总体变化。
共有 68 项研究均符合所有标准，其中 3685 例（3471 例，94.2%确诊）和 332 例（285 例，85.8%确诊）患者分别接受了库欣病和综合征的检测。荟萃分析显示，CRH 刺激诊断库欣病的总体 PPV 为 89.3%（95%CI[83.6%, 94.0%]）。在去氨加压素刺激方面，我们的分析表明，去氨加压素刺激诊断库欣病的总体 PPV 为 96.5%（95%CI[94.5%, 98.1%]）。CRH 刺激 IPSS 在库欣病（p=0.0055）和库欣综合征（p=0.013）的诊断中的应用显著下降。同时，去氨加压素刺激 IPSS 在这两种疾病的诊断中的应用显著增加（p<0.0001）。
我们的发现表明，在 IPSS 刺激技术方面，实践模式发生了重大变化。我们的汇总分析表明，去氨加压素刺激程序的诊断性能优于 CRH 刺激程序。进一步的多机构研究需要特别注意获取敏感性、特异性和其他关键分析的质量数据，以真正评估这一有前途的技术。
