北京大学学报（医学版）2023，Vol.55Issue(6)：1062-1067,6.DOI:10.19723/j.issn.1671-167X.2023.06.017
肾上腺性库欣综合征与无功能腺瘤患者的凝血功能比较及其影响因素
Comparison of coagulation function between adrenocorticotropic hormone indepen-dent Cushing syndrome and nonfunctional adrenal adenoma and its influence factors
摘要
Abstract
Objective:To investigate the coagulation function indicators and identify influence factors of hypercoagulability in patients with adrenocorticotropic hormone(ACTH)independent Cushing syndrome(CS).Methods:In our retrospective study,the electronic medical records system of Peking University First Hospital was searched for the patients diagnosed with ACTH independent CS on discharge from January 2014 to June 2019.Nonfunctional adrenal adenoma patients were chosen as control group and matched 1∶1 by body mass index(BMI),gender,and discharge date.Clinical features and coagulation function indicators were compared between the two groups.Results:In the study,171 patients were in-cluded in each group.Compared with control group,activated partial thromboplastin time(APTT),and prothrombin time(PT)in ACTH independent CS group were significantly lower[(29.22±3.39)s vs.(31.86±3.63)s,P＜0.001;(29.22±3.39)s vs.(31.86±3.63)s,P＜0.001],and both D-dimer and fibrin degradation products(FDP)levels were significantly higher(P＜0.05).Percentage of APTT levels under the lower limit of reference range in the CS patients was significantly higher than that in nonfunctional group(21.6％vs.3.5％,P＜0.001).Percentage of D-dimer levels over the upper limit of reference range in the CS patients was significantly higher than that in nonfunctional group(13.5％vs.6.6％,P=0.041).There were three patients with deep venous thrombosis and one patient with pulmonary embolism in CS group,however none was in control group.The area under curve(AUC)of serum cortisol rhythm(8:00,16:00 and 24:00)levels was negatively associated with the levels of PT(r=-0.315,P＜0.001)and APTT(r=-0.410,P＜0.001),and positively associated with FDP(r=0.303,P＜0.001)and D-dimer levels(r=0.258,P＜0.001).There were no differences in coagulation function indicators among different histopathologic subgroups(adrenocortical adenoma,adre-nocortical hyperplasia,oncocytic adenoma,adrenocortical carcinoma).With Logistic regression analysis,the AUC of cortisol and glycosylated hemoglobin A1c(HbA1c)levels were independent risk factors for hypercoagulability in the ACTH independent CS patients(P＜0.05).Conclusion:ACTH independent CS patients were more likely in hypercoagulable state compared with nonfunctional adrenal adenoma,especially in ACTH independent CS patients with higher levels of cortisol AUC and HbA1c.These pa-tients should be paid attention to for the hypercoagulability and thrombosis risk.关键词
库欣综合征/非促肾上腺皮质激素依赖性/血液凝固/皮质醇/糖化血红蛋白Key words
Cushing syndrome/Adrenocorticotropic hormone independent/Blood coagulation/Corti-sol/Glycated hemoglobin分类
医药卫生引用本文复制引用
王薇,王佳宁,虞巍,朱赛楠,高莹,张俊清..肾上腺性库欣综合征与无功能腺瘤患者的凝血功能比较及其影响因素[J].北京大学学报（医学版）,2023,55(6):1062-1067,6.基金项目
中央高水平医院临床科研业务费及北京大学第一医院临床研究青年基金(2019CR22)Supported by National High Level Hospital Clinical Research Funding and Youth Clinical Research Project of Peking University First Hospital(2019CR22) （2019CR22）
