【摘要】 目的探讨各项生化与影像学检查对Ｃｕｓｈｉｎｇ综合征的诊断价值。方法对经手术和病理证实的３２例Ｃｕｓｈｉｎｇ综合征（Ｃｕｓｈｉｎｇ病所致的肾上腺皮质增生２２例，肾上腺腺瘤８例，肾上腺癌１例，异源性ＡＣＴＨ综合征１例）进行回顾性分析。结果①血皮质醇（Ｆ）单次升高者占８４．４％，昼夜节律失常率为１００％；②２４ｈ尿１７－羟皮质类固醇（１７－ＯＨ）：增生组９０．９％升高，腺瘤组８７．５％升高；③２４ｈ尿游离皮质醇（ＵＦＣ）：测定的８例患者（增生者６例，腺瘤者２例）ＵＦＣ均明显升高（１００％）；④血浆ＡＣＴＨ：测定的８例中，增生者５例升高（５／８，６２．５％），而腺瘤者２例均在正常水平以下，１例异源性ＡＣＴＨ综合征升高；⑤小剂量地塞米松抑制试验（ＤＳＴ）：增生组阳性率均为９５．５％，腺瘤组１００％；⑥大剂量ＤＳＴ：增生组阳性率分别为８１．８％和７２．７％；而腺瘤组均不被抑制（抑制率均＜５０％）；⑦Ｂ超：增生组６８．２％、腺瘤组８７．５％有阳性发现；⑧肾上腺ＣＴ：增生组９０．９％、腺瘤组１００％有阳性发现；颅脑ＣＴ：增生组中的２０例行ＣＴ检查，仅２例（１０％）垂体有阳性发现。结论血Ｆ昼夜节律失常、ＵＦＣ测定与小剂量ＤＳ?更多还原

【Abstract】 Objective To study the diagnostic value of biochemical and imaging examination for Cushing syndrome.Method A retrospective study of 32 cases of Cushing syndrome confirmed by surgery and pathology was presented.In these patients there were 22 cases of Cushing disease,8 cases of adrenal adenomas,1 case of adrenal carcinoma and 1 case of ectopic ACTH syndrome.Result The results showed that 84.4% patients had a elevated plasma cortisol,100% cases had a abnormal cortisol circadian rhythm,urine 17OH were elevated in 90.9% cases of adrenal hyperplasia and in 87.5% of adrenal adenomas,urine free cortisol were elevated in 6/8 cases of adrenal hyperplasia and in 2/8 cases of adrenal adenomas,ACTH were elevated in 5/8 cases of adrenal hyperplasia and 1 case of ectopic ACTH syndrome,2 cases of adrenal adenomas were with a lowered ACTH level, there were 95.5% cases of adrenal hyperplasia and 100% adrenal adenomas with a positive rate in 2 mg dexamethason suppression test(DST),there were 81.8% and 72.7% adrenal hyperplasia with a positive rate in 8 mg DST,while in adenoma group 100% with a negative result,there were 68.2% cases of adrenal hyperplasia and 87.5% adrenal adenomas with a positive rate using ultrasonography.There were 90.9% cases of adrenal hyperplasia and 100% adrenal adenomas with a positive rate using adrenal CT,while cranial CT only had a lower positive rate.[WT5”HX]Conclusion A abnormal cortisol circadian rhythm,elevated UFC and 2mg DST had a higher dianostic value for Cushing syndrome.Adrenal CT,plasma ACTH and 8mg DST had a higher dianostic value for the cause of Cushing syndrome.更多还原