改良岩下窦静脉采血在库欣病诊断中的应用

周薇薇; 苏颋为; 姜蕾; 蒋怡然; 张华; 吴志远; 武鲁铭; 宁光; 王卫庆

doi:10.3760/cma.j.issn.1000-6699.2016.03.004

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中华内分泌代谢杂志

• 肾上腺相关疾病 · Adrenal Gland Related Diseases •

ENGLISH ABSTRACT

改良岩下窦静脉采血在库欣病诊断中的应用

作者及单位信息

出版日期： 2016 -03 -25 ·

DOI： 10.3760/cma.j.issn.1000-6699.2016.03.004

The clinical application of adjusted inferior petrosal sinus sampling in Cushing's disease

Authors Info & Affiliations

Zhou Weiwei

Shanghai National Clinical Center for Endocrine and Metabolic Diseases, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China

Su Tingwei

Jiang Lei

Jiang Yiran

Zhang Hua

Wu Zhiyuan

Wu Luming

Ning Guang

Wang Weiqing

Published： 2016 -03 -25 ·

DOI： 10.3760/cma.j.issn.1000-6699.2016.03.004

1942

141

APP内阅读

摘要

目的岩下窦静脉采血(inferior petrosal sinus sampling, IPSS)有助于确认ACTH依赖性库欣综合征患者中ACTH肿瘤的分泌来源，但存在一定的假阴性。本研究拟通过催乳素校正来改良IPSS技术，探讨其在库欣病诊断中的临床意义。

方法纳入93例ACTH依赖性库欣综合征患者，包括87例库欣病和6例异位ACTH综合征患者。所有患者均进行了催乳素校正的IPSS检查。

结果库欣病患者ACTH岩下窦/外周(inferior petrosal sinus to peripheral gradient, IPS/P)比值和催乳素校正IPS/P比值均显著高于异位ACTH综合征患者[11.3(5.0～22.4)对1.4(1.2～2.0)，3.3(1.9～4.8)对0.5(0.2～1.0)，均 P<0.01]。非改良IPSS的假阴性率为10.3%；经催乳素校正后，IPSS诊断准确性从89.2%提高到96.8%。与其它定位诊断试验比较，催乳素校正IPSS的敏感性和特异性最高。

结论IPSS对鉴别ACTH肿瘤来源而言是一种可信度很高的检查，采用催乳素校正能减少IPSS假阴性结果，有效提高诊断准确性。

关键词：库欣病;岩下窦静脉采血;催乳素

ABSTRACT

ObjectiveInferior petrosal sinus sampling(IPSS)is helpful in confirming the source of ACTH secreting tumor in ACTH-dependent Cushing's syndrome. However, false-negative results have been reported. Prolactin level adjustment may reduce false-negative results of IPSS. This study was to investigate the utility of prolactin measurement during IPSS in patients with Cushing's disease.

MethodsThis study included 93 patients with a pathological diagnosis of Cushing's disease( n=87)or ectopic Cushing's syndrome( n=6). Clinical, biochemical, and radiological records were reviewed and all cases underwent IPSS with prolactin adjustment.

ResultsBaseline and prolactin adjusted inferior petrosal sinus to peripheral gradient(IPS/P)ratio were significantly higher in patients with Cushing's disease than those with ectopic Cushing's syndrome[11.3(5.0-22.4) vs 1.4(1.2-2.0), 3.3(1.9-4.8) vs 0.5(0.2-1.0), both P<0.01]. False-negative rate of baseline IPSS was 10.3%. Prolactin level adjustment could improve the diagnostic accuracy rate of IPSS from 89.2 % to 96.8 % in Cushing's disease. Compared to other diagnostic procedures, the prolactin adjusted IPSS may achieve highest sensitivity and specificity.

ConclusionProlactin normalization may improve the accuracy of IPSS in predicting pituitary ACTH secreting adenoma and is helpful to adjust negative results of IPSS. ( Chin J Endocrinol Metab, 2016, 32: 196-200)

KEYWORDS： Cushing's disease;Inferior petrosal sinus sampling;Prolactin

Corresponding author: Wang Weiqing, Email: mocdef.3ab61wgniqw

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All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

周薇薇,苏颋为,姜蕾,等. 改良岩下窦静脉采血在库欣病诊断中的应用[J]. 中华内分泌代谢杂志,2016,32(3)：196-200.

DOI:10.3760/cma.j.issn.1000-6699.2016.03.004

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未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

1977年Corrigan等 ^{[
1
]}开展了首例岩下窦静脉采血(inferior petrosal sinus sampling, IPSS)，通过比较岩下窦与外周静脉的血促肾上腺皮质激素(adrenocorticotropic hormones, ACTH)来鉴别库欣病和异位ACTH综合征。随后Findling等 ^{[
2
]}于1981年通过一个系列病例证实了IPSS的有效性和安全性。IPSS对鉴别库欣病与异位ACTH综合征有着很高的敏感性和特异性，即便如此仍存在1%～10%的假阴性率。Landolt等 ^{[
3
]}率先采用促肾上腺皮质激素释放激素(corticotropin-releasing hormone, CRH)兴奋来提高IPSS的敏感性。IPSS在技术层面上存在很大的挑战。引起IPSS无法正确定位的常见原因包括置管失败、置管位置不恰当、异常静脉回流、因药物或肾上腺切除致皮质醇水平正常或异位CRH分泌肿瘤。IPSS在诊断库欣病时可能存在假阴性结果，多由双侧垂体静脉分流异常引起，对无中枢优势的IPSS通过回顾插管影像来明确是否采样恰当。垂体发育不良或岩下窦血管丛异常分布有时会导致试验结果假阴性，而异位ACTH综合征患者有时会出现假阳性结果。由于技术及静脉引流异常可能导致假阴性结果，近期有学者尝试通过催乳素校正ACTH测定来进一步来提高IPSS的准确性。本研究拟通过催乳素校正来探讨改良IPSS在库欣病诊断中的临床意义。

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