双侧岩下窦静脉采血在库欣综合征诊断中应用的专家共识(2023)

中国罕见病联盟下丘脑垂体疾病学组; 北京协和医院垂体疾病创新诊疗中心

doi:10.12376/j.issn.2097-0501.2023.03.008

双侧岩下窦静脉采血在库欣综合征诊断中应用的专家共识(2023)

doi: 10.12376/j.issn.2097-0501.2023.03.008

1.
中国医学科学院北京协和医院内分泌科国家卫生健康委员会内分泌重点实验室，北京 100730
2.
中国医学科学院北京协和医院放射科，北京 100730

基金项目:

中央高水平医院临床科研业务费 2022-PUMCH-A-015

中央高水平医院临床科研业务费 2022-PUMCH-B-016

中央高水平医院临床科研业务费 2022-PUMCH-B-114

国家重点研发计划 2022YFC3600203

通信作者：朱惠娟¹，E-mail：shengxin2004@163.com
卢琳¹，E-mail：lulin88@sina.com
张晓波²，E-mail：pumcradiozxb@163.com

详细信息

中图分类号: R586.2
计量
- 文章访问数: 17
- HTML全文浏览量: 4
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-15
- 录用日期: 2023-07-25
- 网络出版日期: 2023-09-09

Expert Consensus on Bilateral Inferior Petrosal Sinus Sampling in the Diagnosis of Cushing′s Syndrome (2023)

1.
Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
2.
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Funding:

National High Leve Hospital Clinical Research Funding 2022-PUMCH-A-015

National High Leve Hospital Clinical Research Funding 2022-PUMCH-B-016

National High Leve Hospital Clinical Research Funding 2022-PUMCH-B-114

The National Key Research and Developmen Program of China 2022YFC3600203

Corresponding authors: ZHU Huijuan¹, E-mail: shengxin2004@163.com
LU Lin¹, E-mail: lulin88@sina.com
ZHANG Xiaobo², E-mail: pumcradiozxb@163.com

摘要

摘要: 库欣综合征(CS)是由多种病因导致的以向心性肥胖、高血压、血糖升高和骨质疏松等为主要表现的临床症候群。对于促肾上腺皮质激素(ACTH)依赖性库欣综合征的患者，在常规影像学检查定位不清的情况下，进行双侧岩下窦静脉采血(BIPSS)是判断ACTH来源的金标准。但BIPSS的适应证、禁忌证、操作流程、注意事项及结果判定在不同医疗中心存在差异，且目前国际上和国内尚无关于BIPSS的临床指南和专家共识发表。为进一步完善BIPSS在疑难CS患者诊断流程中的操作规范，中国罕见病联盟下丘脑垂体疾病学组、北京协和医院垂体疾病创新诊疗中心组织国内内分泌科、放射介入科、神经外科和检验科等相关领域的专家制订该共识，旨在为临床实践中CS鉴别诊断流程使用BIPSS提供规范性的方法学指导。
- 库欣综合征 /
- 双侧岩下窦静脉采血 /
- 库欣病 /
- 异位ACTH分泌综合征 /
- 专家共识
Abstract: Cushing′s syndrome(CS)is a clinical syndrome caused by a variety of causes, with main manifestations exhibited by central obesity, purple skin striae, hypertension, and diabetes. In patients with adrenocorticotropic hormone(ACTH)-dependent CS, the result of bilateral inferior petrosal sinus sampling(BIPSS)is the gold standard for determining the source of ACTH in the absence of routine imaging findings.However, the indications, contraindications, operating procedures, precautions and outcome judgments of BIPSS differ from one medical center to another, and there are currently no international and domestic clinical guidelines and expert consensus on BIPSS. In order to further improve the operation specifications of BIPSS in the diagnosis process of difficult CS, the Hypothalamic and Pituitary Disease Group of the China Alliance for Rare Diseases and the Innovation Center of Pituitary Diseases of Peking Union Medical College Hospital organized experts in endocrinology, interventional radiology, neurosurgery and laboratory in China to formulate this consensus. This consensus aims to provide standardized methodological guidance for the use of BIPSS in the differential diagnostic process of CS in clinical practice.
- Cushing′s syndrome /
- bilateral inferior petrosal sinus sampling /
- Cushing′s disease /
- ectopic ACTH secretion syndrome /
- expert consensus
注释:

作者贡献：朱惠娟牵头制订共识框架，组建共识制订工作组，并审阅定稿；卢琳、陈适带领工作组复习文献，起草共识初稿，组织全国多学科专家讨论、修改，并最后定稿；所有成员参与讨论并形成修订意见；叶红英、闫朝丽、廖志红、葛亮、陈慧玲、张松筠、陈树春、董明、郭辉对共识内容进行修订和审校；张越伦对方法学进行审核。

利益冲突：所有作者均声明不存在利益冲突。

HTML全文

图 1 双侧岩下窦静脉采血(BIPSS)在促肾上腺皮质激素(ACTH)依赖性库欣综合征(CS)中的诊断流程图

IPS/P：中枢和外周；CD：库欣病；DDAVP：醋酸去氨加压素；HDDST：大剂量地塞米松抑制试验；EAS：异位ACTH分泌综合征；PRL：泌乳素

Figure 1. Diagnostic flow diagram of bilateral inferior petrosal sinus sampling (BIPSS) in adrenocorticotropic hormone(ACTH)-dependent Cushing′s syndrome(CS)

下载: 全尺寸图片幻灯片

图 2 BIPSS操作示意图

Figure 2. Schematic diagram of BIPSS operation

下载: 全尺寸图片幻灯片

表 1 本共识的证据等级定义

Table 1. Definitions of levels of evidence for this consensus

证据等级	定义
1a	总结多项随机对照研究的荟萃分析
1b	至少有一项随机对照研究
2a	至少有一项设计良好的对照研究，但未随机分组
2b	至少有一项设计良好的其他类型的准试验研究
3	设计良好的非试验性描述性研究，如比较研究、相关性研究、病例研究等
4	专家委员会的报告或观点，以及权威专家的临床经验

下载: 导出CSV

表 2 本共识的推荐强度定义

Table 2. Recommended intensity definitions for this consensus

推荐强度	定义	证据等级
A(强)	有一项或多项高质量的随机对照研究回答该临床问题	1a、1b
B(中)	针对该问题，有设计良好的临床研究但未随机分组	2a、2b、3
C(弱)	专家委员会的报告或观点，以及权威专家的临床经验，提示本领域需进行高质量的临床研究	4

下载: 导出CSV

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