库欣综合征中地塞米松抑制试验诊断标准与诊断价值的探讨_医学论文.docVIP

库欣综合征中地塞米松抑制试验诊断标准与诊断价值的探讨_医学论文 库欣综合征中地塞米松抑制试验诊断标准与诊断价值的探讨_医学论文 作者：汤正义 张毅 张炜黄 李小英 王卫庆 赵咏桔 宁光 【摘要】 目的 分析库欣与类似库欣综合征病例中地塞米松抑制试验的各种诊断标准与相应的结果，探讨地塞米松抑制试验的最合适诊断标准与临床价值。方法 收集近25年有手术病理明确病因的库欣综合征病人246例，近5年临床能排除库欣综合征的类库欣病人43例，经1mg、2mg、8mg地塞米松抑制试验，用不同的诊断标准，统计分析试验结果与实际病因的准确性。结果 所有库欣综合征病人在1mg地塞米松抑制后血皮质醇大于1.8μg/dl，94.6%的病人大于5μg/dl；2mg地塞米松抑制后多种诊断标准在库欣综合征病人中均较好，其中尿游离皮质醇抑制后诊断标准应调整为对照值的50%并在正常范围内；小剂量地塞米松抑制试验对类库欣情况鉴别均较差；8mg地塞米松试验能抑制的病人基本可诊断为库欣病(准确性97.0%)，但有17.7%的病人不抑制，其他病因的库欣综合征基本不抑制(准确性93.4%)。结论 地塞米松抑制试验结果与库欣综合征临床检查结果有较好的一致性；该试验对临床不典型情况准确性较差，但结合其他指标，仍有较好的参考价值。 【关键词】 库欣综合征 地塞米松抑制试验 垂体肾上腺轴 The standards and clinical value of dexamethasone suppression tests 【Abstract】 Objective The results of dexamethasone suppression tests acquired with several kinds of diagnostic standards were analyzed to find the clinical value and most suitable diagnostic standards.Methods 246 patients with Cushing’s syndrome confirmed by pathological diagnosis were collected in the past 25 years， and 43 patients with some situations needed to differentiate with Cushing’s syndrome were collected in recent 5 years.Using 1mg， 2mg， and 8mg dexamethasone suppression tests in the material were distinguished with different diagnostic standards， and then compared with the pathological diagnosis.Results After suppression of 1mg dexamethasone， the plasma cortisol of all patients with Cushing’s syndrome were more than 1.8μg/dl， and 94.6% patients’more than 5μg/dl. Several kinds of diagnostic standards were good when used for 2mg dexamethasone suppression test in Cushing’s syndrome， among them， the standard for urine free cortisol after suppression should be adjusted to 50% of the contrast and the assayed data should in normal limits. Low dose dexamethasone suppression tests were not satisfied when used among the patients with some situations needed to differentiate with Cushing’s syndrome. Suppressed by 8 mg dexamethasone could direct the diagnose of Cushing’s disease (97.0%)， though 17.7% of this kind of patients cou