早期术后的LDDST增强了在库希氏病中超越早晨皮质醇的缓解预测
Isabella Nasi-Kordhishti1,2, Linda Oberle3,4, Kateryna Goloshchapova3,5
1Department of Neurosurgery, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Strasse 3, Tübingen, 72076, Germany. isabella.nasi-kordhishti@med.uni-tuebingen.de.
Pituitary
|February 9, 2026
概括
早晨的皮质醇和低剂量德克萨米他抑制试验 (LDDST) 可靠地预测了库辛病的跨形手术后的缓解. 这些测试有助于评估手术后的早期和长期成功.
科学领域:
- 内分泌学 在内分泌学.
- 神经外科 神经外科
- 手术瘤学手术瘤学
背景情况:
- 跨形手术 (TSS) 是库辛病 (CD) 的首要治疗方法.
- 评估TSS后的早期缓解对于患者管理至关重要.
- 早期术后测试对长期结果的预测价值需要澄清.
研究的目的:
- 为了比较早期手术后的早晨血清皮质醇 (MSeC) 和一夜间2毫克低剂量德克萨米他抑制试验 (LDDST) 在预测CDTSS后缓解的准确性.
- 评估这些测试对早期和长期缓解评估的有用性.
主要方法:
- 在2004年至2024年期间,对342名接受TCS治疗CD的患者进行了回顾性分析.
- 收集了手术后的MSeC测量结果.
- 在选定的情况下,在术后第五天进行了2毫克LDDST,特别是那些没有立即生化缓解的病例.
主要成果:
- 在49.7%的病例中观察到立即术后生化缓解 (MSeC < 50nmol/L).
- 在69.5%的受试患者中,LDDST显示完全抑制 (<50nmol/L).
- 无论是IPBR还是LDDST,都与较高的早期和长期缓解率有显著的相关性 (p < .0001). ROC分析显示出强大的预测准确性 (AUC MSeC: 0.9229,LDDST: 0.9413用于早期缓解;AUC MSeC: 0.8267,LDDST: 0.8058用于长期缓解). 在抑制LDDST的情况下,五年复发风险显著降低 (6.8%与71.1%相比).
结论:
- 早期的术后MSeC和LDDST是CD的TSS后缓解的可靠预测因素.
- MSeC < 50 nmol/L 是生化缓解的安全指标.
- LDDST提供了额外的诊断价值,特别是在MSeC结果模两可的情况下,应该成为例行术后评估的一部分.
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