[1]王薇,高莹,朱赛楠,等.非ACTH依赖性库欣综合征合并心功能不全患者的临床特点分析[J].国际内分泌代谢杂志,2022,42(02):96-101.[doi:10.3760/cma.j.cn121383-20210603-06007]
　Wang Wei,Gao Ying,Zhu Sainan,et al.Analysis of clinical characteristics of patients with ACTH-independent Cushing's syndrome complicated with cardiac insufficiency[J].International Journal of Endocrinology and Metabolism,2022,42(02):96-101.[doi:10.3760/cma.j.cn121383-20210603-06007]
点击复制

非ACTH依赖性库欣综合征合并心功能不全患者的临床特点分析()
分享到：

《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
42
期数:
2022年02期
页码:
96-101
栏目:
论著
出版日期:
2022-03-20

文章信息/Info

Title:
Analysis of clinical characteristics of patients with ACTH-independent Cushing's syndrome complicated with cardiac insufficiency
作者:
王薇1; 高莹1; 朱赛楠2; 张争3; 张俊清1
1北京大学第一医院内分泌科 100034; 2北京大学第一医院医学统计室 100034; 3北京大学第一医院泌尿外科 100034
Author(s):
Wang Wei1;  Gao Ying1;  Zhu Sainan2;  Zhang Zheng3;  Zhang Junqing1.
1Department of Endocrinology, Peking University First Hospital, Beijing 100034, China; 2Department of Medical Statistics, Peking University First Hospital, Beijing 100034, China; 3Department of Urology, Peking University First Hospital, Beijing 100034, China
关键词:
库欣综合征;  非ACTH依赖性;  心功能不全;  临床特点
Keywords:
Cushing's syndrome;  ACTH independent;  Cardiac insufficiency;  Clinical features
DOI:
10.3760/cma.j.cn121383-20210603-06007
摘要:
目的 总结非促肾上腺皮质激素(ACTH)依赖性库欣综合征(CS)合并心功能不全患者的临床特点,为在非ACTH依赖性CS患者中更好地识别出心功能不全的高危人群提供理论依据。方法 收集以“非ACTH依赖性CS”为检索词,在北京大学第一医院住院电子病例系统中检索2014年1月至2019年3月出院诊断为非ACTH依赖性CS的病例资料。根据患者心功能情况分为两组:心功能不全组及对照组。比较两组患者的临床特点。结果 心功能不全组与对照组相比,左室射血分数显著降低[(61.50±11.07)%比(70.61±5.67)%,P=0.005],室间隔厚度及左室后壁厚度均显著升高,血清皮质醇节律和24 h尿皮质醇均显著升高,服用降压药种类更多,糖化血红蛋白水平更高。室间隔厚度与血清皮质醇的曲线下面积呈显著正相关(r=0.370,P<0.001),左室后壁厚度与血清皮质醇的曲线下面积呈显著正相关(r=0.257,P=0.003)。Logistic回归分析显示,发生心功能不全的独立危险因素包括低钾血症病史、血清皮质醇曲线下面积大于335.36(μg/dl)·h、左室射血分数小于60%、左室后壁厚度大于1.1 cm(P均<0.05)。结论 非ACTH依赖性CS合并心功能不全患者的主要表现为室间隔和左室后壁增厚、左室射血分数轻度下降、更难控制的高血糖和高血压。发生心功能不全的危险因素包括低钾血症病史、严重升高的皮质醇水平、左室射血分数降低及左室后壁增厚。
Abstract:
Objective The clinical characteristics of patients with adrenocorticotropic hormone(ACTH)independent Cushing's syndrome(CS)complicated with cardiac insufficiency were summarized and analyzed, in order to provide a better identification for high risk populations of heart dysfunction in patients with ACTH independent CS.Methods The patients diagnosed with ACTH independent CS were searched from the electronic medical records system of Peking University First Hospital on discharge from January 2014 to March 2019. These patients were divided into two groups: cardiac insufficiency group and control group. The clinical features of two groups were compared.Results Compared to control group, patients in cardiac insufficiency group had significantly decreased left ventricular ejection fraction(LVEF)[(61.50±11.07)% vs.(70.61±5.67)%, P=0.005], thicker interventricular septum and left ventricular posterior wall, higher levels of serum cortisol rhythm, 24-hour urine free cortisol and glycosylated hemoglobin A1c, as well as more antihypertensive drugs. Thickness of interventricular septum was positively associated with area under curve of serum cortisol rhythm(r=0.370, P<0.001). Thickness of left ventricular posterior wall was also positively associated with area under curve of serum cortisol rhythm(r=0.257, P=0.003). The risk factors of cardiac insufficiency for patients with ACTH independent CS included a hypokalemia history, area under curve of serum cortisol rhythm more than 335.36(μg/dl)·h, LVEF less than 60%, and thickness of left ventricular posterior wall more than 1.1 cm in CS(all P<0.05).Conclusions The main clinical manifestations of ACTH independent CS with cardiac insufficiency are thicker interventricular septum and left ventricular posterior wall, decreased LVEF, more difficult control of hyperglycemia and hypertention. Patients with a hypokalemia history, higher level of serum cortisol, decreased LVEF and thicker left ventricular posterior wall will more likely to complicate with cardiac insufficiency.

参考文献/References:

[1] Muiesan ML,Lupia M,Salvetti M,et al.Left ventricular structural and functional characteristics in Cushing's syndrome[J].J Am Coll Cardiol,2003,41(12):2275-2279.DOI:10.1016/s0735-1097(3):00493-5.
[2] Pivonello R,De Martino MC,Iacuaniello D,et al.Metabolic alterations and cardiovascular outcomes of cortisol excess[J].Front Horm Res,2016,46:54-65.DOI:10.1159/000443864.
[3] Chen Y,Qi B.Representation learning in intraoperative vital signs for heart failure risk prediction[J].BMC Med Inform Decis Mak,2019,19(1):260.DOI:10.1186/s12911-019-0978-6.
[4] Pivonello R,Isidori AM,De Martino MC,et al.Complications of Cushing's syndrome:state of the art[J].Lancet Diabetes Endocrinol,2016,4(7):611-629.DOI:10.1016/S2213-8587(16)00086-3.
[5] Takano H,Kokubu A,Sugimoto K,et al.Left ventricular structural and functional abnormalities in dogs with hyperadrenocorticism[J].J Vet Cardiol,2015,17(3):173-181.DOI:10.1016/j.jvc.2015.07.002.
[6] Ainscough JF,Drinkhill MJ,Sedo A,et al.Angiotensin Ⅱ type-1 receptor activation in the adult heart causes blood pressure-independent hypertrophy and cardiac dysfunction[J].Cardiovasc Res,2009,81(3):592-600.DOI:10.1093/cvr/cvn230.
[7] Brilla CG,Weber KT.Mineralocorticoid excess,dietary sodium,and myocardial fibrosis[J].J Lab Clin Med,1992,120(6):893-901.
[8] 中华医学会内分泌学分会.库欣综合征专家共识(2011年)[J].中华内分泌代谢杂志,2012,28(2):96-102.DOI:10.3760/cma.j.issn.1000-6699.2012.02.002.
[9] 中华医学会糖尿病学分会.中国 2型糖尿病防治指南(2020年版)[J].中华糖尿病杂志,2021,13(4):317-411.DOI:10.3760/cma.j.cn115791-20210221-00095.
[10] 中国高血压防治指南修订委员会,高血压联盟(中国),中华医学会心血管病学分会中国医师协会高血压专业委员会,中国医疗保健国际交流促进会高血压分会,中国老年医学学会高血压分会等.中国高血压防治指南(2018年修订版)[J].中国心血管杂志,2019,24(2):24-56.DOI:10.3969 / j.issn.1007-5410.2019.01.002.
[11] Takagi S,Tanabe A,Tsuiki M,et al.Hypokalemia,diabetes mellitus,and hypercortisolemia are the major contributing factors to cardiac dysfunction in adrenal Cushing's syndrome[J].Endocr J,2009,56(8):1009-1018.DOI:10.1507/endocrj.k09e-198.
[12] 王华,李莹莹,柴坷,等.中国住院心力衰竭患者流行病学及治疗现状[J].中华心血管病杂志,2019,47(11):865-874.DOI:10.3760/cma.j.issn.0253-3758.2019.11.004.
[13] 易诗欣,黎励文.射血分数保留的心力衰竭是射血分数降低的心力衰竭的早期表现[J].中华心血管病杂志,2017,45(6):480-481.DOI:10.3760/cma.j.issn.0253-3758.2017.06.007.
[14] Borlaug BA.Evaluation and management of heart failure with preserved ejection fraction[J].Nat Rev Cardiol.2020,17(9):559-573.DOI:10.1038/s41569-020-0363-2.
[15] Duprez D,De Buyzere M,Paelinck M,et al.Relationship between left ventricular mass index and 24-h urinary free cortisol and cortisone in essential arterial hypertension[J].J Hypertens,1999,17(11):1583-1588.DOI:10.1097/00004872-199917110-00012.
[16] Diamond JA,Phillips RA.Hypertensive heart disease[J].Hypertens Res,2005,28(3):191-202.DOI:10.1291/hypres.28.191.
[17] Faggiano A,Pivonello R,Spiezia S,et al.Cardiovascular risk factors and common carotid artery caliber and stiffness in patients with Cushing's disease during active disease and 1 year after disease remission[J].J Clin Endocrinol Metab,2003,88(6):2527-2533.DOI:10.1210/jc.2002-021558.

相似文献/References:

[1]徐剑,吴庆波,钟历勇,等.岩下窦取血在诊断ACTH依赖性库欣综合征中的应用[J].国际内分泌代谢杂志,2007,(04):244.
[2]杜琴 赵蓓蓓 高玉婷 李冰玲 蔡国杰 蔡珂 李延兵 廖志红.串联质谱法检测尿皮质醇和唾液皮质醇在库欣综合征诊断中的研究进展[J].国际内分泌代谢杂志,2020,40(01):39.[doi:10.3760/cma.j.issn.1673-4157.2020.01.009]
　Du Qin,Zhao Peipei,Gao Yuting,et al.Research progress in the detection of urinary cortisol and salivary cortisol by tandem mass spectrometry in the diagnosis of Cushing's syndrome[J].International Journal of Endocrinology and Metabolism,2020,40(02):39.[doi:10.3760/cma.j.issn.1673-4157.2020.01.009]
[3]李佳琦,孙丽思,余叶蓉.库欣综合征筛查试验的选择和临床应用[J].国际内分泌代谢杂志,2021,41(06):573.[doi:10.3760/cma.j.cn121383-20210831-08083]
　Li Jiaqi,Sun Lisi,Yu Yerong..Selection and clinical application of screening tests for Cushing's syndrome[J].International Journal of Endocrinology and Metabolism,2021,41(02):573.[doi:10.3760/cma.j.cn121383-20210831-08083]
[4]吴晗,徐丹,王君,等.妊娠诱发库欣综合征的诊疗进展[J].国际内分泌代谢杂志,2024,44(01):47.[doi:10.3760/cma.j.cn121383-20230722-07028]
　Wu Han,Xu Dan,Wang Jun,et al.Clinical advances in pregnancy-induced Cushing's syndrome[J].International Journal of Endocrinology and Metabolism,2024,44(02):47.[doi:10.3760/cma.j.cn121383-20230722-07028]

备注/Memo

备注/Memo:
通信作者:张俊清,Email:junqing.zhang@pkufh.com
基金项目:北京大学第一医院临床研究青年基金(2019CR22)
更新日期/Last Update: 2022-04-20