在诊断轻度自主皮质醇分泌和上腺衰竭时使用脱水二酸盐
Jasmine Saini1,2, Bahaa Salama1, Kai Yu1,3
1Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA.
Journal of the Endocrine Society
|September 5, 2025
概括
在诊断轻微的自主皮质醇分泌 (MACS) 和上腺功能不全 (AI) 方面,脱氨硫酸 (DHEA-S) 是有前途的. 这一元分析表明DHEA-S测量为这些疾病提供了额外的诊断价值.
科学领域:
- 内分泌学
- 临床诊断
- 综合分析
背景情况:
- 在轻度自主皮质醇分泌 (MACS) 和上腺功能不全 (AI) 中,脱氨硫酸 (DHEA- S) 的诊断准确性数据不一致.
- 现有研究显示DHEA-S对诊断MACS和AI的有用性存在矛盾.
研究的目的:
- 对MACS和AI的DHEA-S诊断准确性进行系统审查和分析.
- 在诊断这些上腺疾病时,提供对DHEA- S的敏感性和特异性的综合估计.
主要方法:
- 系统地搜索原始研究的数据库 (开始至2024年1月8日),至少有20名参与者被诊断患有MACS或AI.
- 定义的MACS为后甲松皮质醇>1.8mcg/dL或手术后的皮质过低;AI通过异常动态测试.
- 使用 QUADAS-2 进行偏差风险评估和双变随机效应元分析以提高诊断准确性.
主要成果:
- 包括7项针对MACS的研究 (574名MACS患者,830名对照) 和2项针对AI的研究 (52名AI患者,59名对照).
- 在MACS诊断中,DHEA- S截止值为60 - 70微克/分升:综合灵敏度为82% (95% CI,64% - 93%),特异性为82% (95% CI,74% - 88%).
- 对于AI诊断,DHEA- S灵敏度在70. 3% - 86. 7%之间,特异性为87. 1% (使用1mcg的可辛托试验作为参考). 大多数研究具有中等偏差风险.
结论:
- 尽管证据有限且异质,但DHEA-S测量似乎为MACS提供了额外的诊断价值.
- 这些发现表明DHEA-S可以帮助诊断上腺功能缺陷 (AI).
- 需要进一步的高质量研究来证实这些诊断能力.
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