库欣综合征合并糖代谢异常41例临床分析

目的探讨库欣综合征合并糖代谢异常(IGM)的临床特征。方法回顾性分析1999年1月～2005年5月在本院住院的库欣综合征94例临床资料。结果库欣综合征合并IGM患病率43.6%,其中合并糖尿病(DM)33.0%,糖耐量低减(IGT)10.6%;与糖耐量正常(NGT)组相比,IGM组病程较长(P<0.01),年龄较大(P<0.05),血脂紊乱患病率显著增高(P<0.01),多发性脑梗塞患病率较高(P<0.05),体重指数及24小时尿游离皮质醇(UFC)差异无显著性(P>0.05),24小时UFC与糖化血红蛋白(HbAlc)无相关性(P>0.05)。糖尿病组血糖轻、中度升高,大多数应用1～2种降糖药血糖可控制良好,并发糖尿病酮症仅1例。41例IGM中库欣综合征治疗27例,其中26例随着库欣综合征病情的控制,血糖逐渐恢复正常,4例随着库欣综合征病情复发,血糖又增高。结论库欣综合征合并IGM患病率较高。合并IGM组病程较长、年龄较大,更容易并发血脂紊乱、多发性脑梗塞;但糖尿病酮症发生率低;高糖皮质激素水平得到纠正后,IGM可治愈或缓解。

The clinical analysis of 41 cases of Cushing syndrome with impaired glucose metabolism

Objective To observe the clinical characteristics of Cushing syndrome with impaired glucose metabolism (IGM).Methods The clinical data of 94 inpatient cases of Cushing Syndrome from January 1999 to May 2005 were retrospectively analyzed.Results The prevalence of Cushing syndrome with IGM was 43.6%,33.0% of diabetes mellitus(DM),and 10.6% of impaired glucose tolerance (IGT).The diseace course and age in IGM group were higher than those with normal glucose tolerance (NGT).Compared to NGT group,IGM group had higher prevalence of dyslipidemia(P<0.01) and multiple cerebral infarcion (P<0.05).While there were no difference of urinary free cortisol (UFC) in 24 hour and BMI between the two groups(P>0.05).In IGM group,the HbA1c level was not related to 24h UFC(P>0.05).The hyperglycemia level was mild to moderate in diabetes group, and could be well controlled by one or two hypoglycemic agents.The ketonuria could be detected only in one person.Of 41 cases IGM,27 were treated of Cushing syndrome.IGM were relieved with the control of Cushing syndrome in 26 cases,while reappeared with the relapse of Cushing syndrome in 4 patients.Conclusion The prevalence of IGM was higher in Cushing syndrome,especially in patients with long diseace course and in aged persons.Cushing syndrome with IGM had higher prevalence of dyslipidemia and multiple cerebral infarcion,but low prevalence of ketonuria and could be relieved by correcting of Cushing syndrome.