摘要：

目的 筛查库欣病患者经鼻蝶入路手术后即刻缓解的影响因素。方法 纳入2014年1月至2020年8月在中国医学科学院北京协和医院行经鼻蝶入路手术的420例库欣病患者，单因素和多因素Logistic回归分析筛查术后即刻缓解的影响因素，绘制受试者工作特征曲线（ROC曲线）预测术后即刻缓解的截断值。结果 术后即刻缓解率为75.71%（318/420），Logistic回归分析显示，非首次手术（OR=3.904，95% CI：2.199~6.930；P=0.000）和术前高血浆促肾上腺皮质激素（ACTH）水平（OR=0.995，95% CI：0.991~0.999；P=0.027）是术后即刻缓解的危险因素。ROC曲线显示，术前血浆ACTH预测术后即刻缓解的曲线下面积为0.586（95% CI：0.524~0.648，P=0.009），灵敏度为0.510，特异度为0.640，最佳阈值为85.45 pg/ml。结论 非首次手术和术前高血浆ACTH水平是库欣病患者经鼻蝶入路手术后即刻缓解的危险因素，内分泌科和神经外科医师在术前评估时应充分注意上述预后影响因素，并以此为依据做好医患沟通。

关键词: 库欣综合征, 垂体肿瘤, 促肾上腺皮质激素, Logistic模型

Abstract:

Objective To explore the preoperative factors affecting the immediate remission of Cushing's disease after transsphenoidal surgery. Methods A total of 420 patients with Cushing's disease (led by Dr. Feng Ming) in the Department of Neurosurgery of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2014 to August 2020 were included. Univariate and multivariate Logistic regression analyses were performed to find risk factors for immediate remission after operation of Cushing's disease, and receiver operating characteristic curve (ROC) was used to predict the cut-off value of immediate remission after operation. Results Among 420 patients with Cushing's disease, 318 patients had immediate remission after operation, and the immediate remission rate was 75.71%. Logistic regression analysis showed that non-primary surgery (OR=3.904, 95%CI: 2.199-6.930; P=0.000) and high adrenocorticotropic hormone level (OR=0.995, 95%CI: 0.991-0.999; P=0.027) were risk factors for immediate remission after opration in patients with Cushing's disease. ROC showed the area under the curve (AUC), sensitivity and specificity of 85.45 pg/ml adrenocorticotropic hormone level (best threshold) for predicting immediate remission after operation were 0.586 (95%CI: 0.524-0.648, P=0.009), 0.510 and 0.640. Conclusions Preoperative adrenocorticotropic hormone and the first operation are important factors affecting the immediate remission of patients with Cushing's disease after transsphenoidal operation. Endocrinologists and neurosurgeons should pay attention to the factors affecting the prognosis of patients during the preoperative evaluation of patients with Cushing's disease and make good communication between doctors and patients.

Key words: Cushing syndrome, Pituitary neoplasms, Adrenocorticotropic hormone, Logistic models