Objective: To determine the effect of the surgical and conservative approaches on the metabolic profiles in patients with subclinical Cushing's syndrome (SCS) in adrenal incidentalomas (AI). Methods: A hundred and thirty AI patients with SCS in Department of Endocrinology, PLA General Hospital between January 2008 and December 2016 were studied, surgery was performed in 88 patients (surgical group), and the rest received conservative approach (conservative group). The improvement/worsening of blood pressure, blood glucose, lipid profiles and body weight after a duration of >18 months follow-up were analyzed, respectively. Results: Baseline demographics, clinical characteristics were similar between surgical and conservative groups. In the surgical group, blood pressure, blood glucose, lipid profiles and body weight improved more frequently than that in conservative group (29.69% vs 3.12%, P=0.003; 10.94% vs 3.12%, P=0.262; 7.81% vs 3.12%, P=0.660; 39.06% vs 9.38%, P=0.004, respectively). In conservative group, blood pressure, blood glucose, lipid profiles and body weight worsened more frequently than that in surgical group (28.13% vs 0, P<0.001; 25.0% vs 0, P<0.001; 18.75% vs 0, P=0.003; 40.62% vs 20.31%, P=0.051, respectively). Logistic regression analysis indicated surgical treatment was associated with improvement of blood pressure (OR=10.687, 95%CI: 1.279-89.299) and weight loss (OR=5.541, 95%CI: 1.404-21.872) independently of gender, age, duration of follow-up, serum cortisol level after 1 mg-dexamethasone suppression test and the mass size. Conclusion: In AI patients with SCS, surgery was beneficial in the aspect of metabolic profiles.
目的： 探讨肾上腺意外瘤(AI)中亚临床库欣综合征(SCS)的最佳治疗方案。 方法： 回顾性分析2008年1月—2016年12月在解放军总医院内分泌科住院诊治的AI患者的病例资料，选取130例确诊且资料完整的SCS患者为研究对象，依据是否手术分为手术治疗组和保守治疗组，对两组患者进行随访观察，以血压、血糖、血脂、体重改善情况作为研究终点，比较两种治疗方案的临床获益。 结果： 共纳入130例患者，手术治疗组88例、保守治疗组42例。对所有患者进行电话随访，手术治疗组失访10例(11.36%)，排除14例随访时间≤18个月者，最终共64例纳入研究，男19例，女45例，年龄(52.1±9.5)岁；保守治疗组失访4例(9.52%)，排除6例随访时间≤18个月者，最终共32例，男12例，女20例，年龄(54.0±8.9)岁。手术治疗组随访21.5～45.7(28.2±19.0)个月，保守治疗组随访23.2～53.1(36.1±16.6)个月。随访结束时，手术治疗组血压、血糖、血脂、体重的改善率分别为29.69%、10.94%、7.81%、39.06%，恶化率分别为0、0、0、20.31%。保守治疗组改善率分别为3.12%、3.12%、3.12%、9.38%，恶化率分别为28.13%、25.00%、18.75%、40.62%。多因素logistic回归分析显示，校正性别、年龄、随访时间、基线状态午夜1 mg地塞米松抑制试验后血清皮质醇水平及瘤体最大径后，手术治疗可以改善血压，降低体重，OR值分别为10.687(95%CI：1.279～89.299)和5.541(95%CI：1.404～21.872)，均P<0.05。 结论： 对于AI中SCS患者，手术治疗有利于改善血压、降低体重，其在心血管危险因素改善方面优于单纯保守治疗。.
Keywords: Adrenal gland neoplasms; Adrenalectomy; Follow-up studies; Subclinical Cushing′s syndrome; Treatment outcome.