库欣综合征伴围手术期肺栓塞临床特点分析

doi:10.3969/j.issn.1672-6731.2021.03.009

中国现代神经疾病杂志 ›› 2021, Vol. 21 ›› Issue (3): 177-184. doi: 10.3969/j.issn.1672-6731.2021.03.009

2 库欣综合征伴围手术期肺栓塞临床特点分析

孙旭¹, 卢琳¹, 冯铭², 朱惠娟¹, 姚勇², 王任直²

1 100730 中国医学科学院北京协和医学院北京协和医院内分泌科国家卫生健康委员会内分泌重点实验室协和转化医学中心;
2. 100730 中国医学科学院北京协和医学院神经外科

收稿日期:2021-03-23 出版日期:2021-03-25 发布日期:2021-04-02
通讯作者: 卢琳,Email:lulin88@sina.com
基金资助:
国家重点研发计划项目（项目编号：2016YFC0901500）；中国医学科学院医学与健康科技创新工程项目（项目编号：2017-I2M-1-011）；中国医学科学院中央级公益性科研院所基本业务资助项目（项目编号：2017PT32020）；中国医学科学院中央级公益性科研院所基本业务资助项目（项目编号：2018PT32001）

Analysis of clinical characteristics of Cushing's syndrome complicated with pulmonary embolism during perioperative period

SUN Xu¹, LU Lin¹, FENG Ming², ZHU Hui-juan¹, YAO Yong², WANG Ren-zhi²

1 Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translational Medicine Center of Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
2 Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Received:2021-03-23 Online:2021-03-25 Published:2021-04-02
Supported by:
This study was supported by the National Key Research and Development Program of China (No. 2016YFC0901500), the Chinese Academy of Medical Sciences Innovation Fund for Medical Science (No. 2017-I2M-1-011), and the Non-Profit Central Research Institute Fund of Chinese Academy of Medical Sciences (No. 2017PT32020, 2018PT32001).

摘要/Abstract

摘要：

目的回顾分析库欣综合征伴围手术期肺栓塞患者的临床特点。方法纳入中国垂体疾病注册中心中国医学科学院北京协和医院分中心垂体瘤数据库2013年1月1日至2020年9月30日共20例库欣综合征伴围手术期肺栓塞患者，总结其临床症状、体格检查和实验室检查，根据病因分为库欣病、异位促肾上腺皮质激素综合征和肾上腺腺瘤，根据肺栓塞发生时间分为术前肺栓塞和术后肺栓塞，对比分析其临床特点。结果根据病因分为库欣病（7例）、异位促肾上腺皮质激素综合征（9例）和肾上腺腺瘤（4例），仅库欣病病程长于异位促肾上腺皮质激素综合征（t=-2.938，P=0.011）。根据肺栓塞发生时间分为术前肺栓塞（13例）和术后肺栓塞（7例），术后肺栓塞患者体重指数低于（t=2.427，P=0.026）、纤维蛋白原高于（t=-2.162，P=0.047）术前肺栓塞患者。术后发生肺栓塞的7例患者中2例术后清晨血清皮质醇< 138 nmol/L，达病情缓解，余5例高皮质醇血症并未缓解；与术前基线相比，术后红细胞计数（t=-2.032，P=0.042）和血红蛋白（t=9.807，P=0.001）降低，凝血酶原时间（t=-2.847，P=0.047）和国际标准化比值（t=-3.059，P=0.038）升高。结论病程较长、术后高皮质醇血症未缓解可能为库欣综合征患者围手术期发生肺栓塞的危险因素。术前纤维蛋白原升高、术后红细胞计数和血红蛋白降低的患者应警惕术后肺栓塞的风险。

关键词: 库欣综合征, 肺栓塞, ACTH综合征, 异位, 围手术期

Abstract:

Objective To retrospectively analyze the clinical characteristics of patients with Cushing's syndrome (CS) complicated with perioperative pulmonary embolism (PE). Methods Depending on Chinese Pituitary Disease Registry Network (CPDRN) and Pituitary Tumor Database in Peking Union Medical College Hospital, 20 patients with CS complicated perioperative PE were collected from January 1, 2013 to September 30, 2020, and the clinical manifestations and laboratory examination data of the patients were investigated. The clinical characteristics were compared between ectopic adrenocorticotropic hormone syndrome (EAS) and CS with PE during the perioperative period. In addition, clinical characteristics were also studied in these patients before and after the operation. Results According to etiology, they were divided into CS (7 cases), EAS (9 cases) and adrenal adenoma (4 cases). The course of CS was longer than EAS (t=-2.938, P=0.011). According to the occurrence time of PE, the patients were divided into preoperative PE (13 cases) and postoperative PE (7 cases). The patients with postoperative PE had a lower body mass index (t=2.427, P=0.026) and a higher fibrinogen (t=-2.162, P=0.047). The patients with PE before surgery included 5 cases of CS, 5 cases of EAS, and 3 cases of adrenal adenomas, while those who with PE after surgery included 2 cases of CS, 4 cases of EAS, and one case of adrenal adenoma. Among the 7 patients with PE after surgery, 5 cases did not get remission. Compared with preoperative examination, the erythrocyte count (t=-2.032, P=0.042) and hemoglobin (t=9.807, P=0.001) were decreased after operation, the prothrombin time (t=-2.847, P=0.047) and international normalized ratio (t=-3.059, P=0.038) were increased after operation. Conclusions Longer course of disease and no remission hypercortisolemia after surgery may be the risk factors for perioperative PE in CS patients. Patients with elevated fibrinogen before surgery and reduced red blood cell count and hemoglobin after surgery should be alert to the risk of PE.

Key words: Cushing syndrome, Pulmonary embolism, ACTH syndrome, ectopic, Perioperative period

孙旭, 卢琳, 冯铭, 朱惠娟, 姚勇, 王任直. 库欣综合征伴围手术期肺栓塞临床特点分析[J]. 中国现代神经疾病杂志, 2021, 21(3): 177-184.

SUN Xu, LU Lin, FENG Ming, ZHU Hui-juan, YAO Yong, WANG Ren-zhi. Analysis of clinical characteristics of Cushing's syndrome complicated with pulmonary embolism during perioperative period[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2021, 21(3): 177-184.

http://journal11.magtechjournal.com/cjcnn/CN/Y2021/V21/I3/177

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