免疫检查点抑制剂治疗期间的上腺功能缺陷:如何简化诊断途径?
Alice Nervo1, Giovanni Gruosso1, Marta Marino2
1Oncological Endocrinology Unit, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy.
Clinical endocrinology
|August 28, 2025
概括
在接受免疫检查点抑制剂 (ICI) 的患者中,早期发现上腺功能缺陷 (AI) 是至关重要的. 这项研究表明,改善早晨血清皮质醇切断值可以减少进一步测试的需要,改善AI诊断.
科学领域:
- 内分泌学
- 癌症学
- 临床诊断
背景情况:
- 在接受免疫检查点抑制剂 (ICI) 的患者中,上腺功能不足 (AI) 是一个关键问题.
- 在ICI治疗期间诊断AI存在重大挑战.
- 早期检测对于预防严重的健康并发症至关重要.
研究的目的:
- 在ICI治疗患者中改进AI的诊断标准.
- 通过优化早晨血清皮质醇 (SC) 截止值来减少动态测试的需要.
- 探索唾液皮质醇和皮质素作为替代生物标志物的实用性.
主要方法:
- 对接受ICI治疗的癌症患者进行前性观察研究.
- 分析早晨的SC,低剂量ACTH刺激测试后的峰值SC,以及唾液皮质醇/皮质素.
- 对AI诊断的不同SC值 (内分泌学会的指导方针和测试特定的切断值) 的评估.
主要成果:
- 在早晨和峰值刺激的SC之间发现了强烈的正相关性 (r=0. 72).
- 接收器操作特征 (ROC) 曲线分析定义了AI预测和排除的最佳早晨SC值.
- 醒来时唾液皮质醇和皮质素与峰值刺激的SC呈现正相关性 (分别为r=0. 49和r=0. 56).
结论:
- 清晨血清皮质醇是一种可靠的ICI相关AI查工具.
- 实施测试特定的切断值可以减少动态刺激试验的必要性.
- 在特定的临床场景中,唾液激素分析可能是切实可行的替代方案.
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