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Abstract：
Cushing\'s disease (CD) poses significant challenges in its treatment due to the lack of reliable biomarkers for predicting tumor localization or postoperative clinical outcomes. Sphingosine-1-phosphate (S1P) has been shown to increase cortisol biosynthesis and is regulated by adrenocorticotropic hormone (ACTH).
We employed bilateral inferior petrosal sinus sampling (BIPSS), which is considered the gold standard for diagnosing pituitary sources of CD, to obtain blood samples and explore the clinical predictive value of the S1P concentration ratio in determining tumor laterality and postoperative remission. We evaluated 50 samples from 25 patients who underwent BIPSS to measure S1P levels in the inferior petrosal sinuses bilaterally.
Serum S1P levels in patients with CD were significantly higher on the adenoma side of the inferior petrosal sinus than on the nonadenoma side (397.7 ± 15.4 vs. 261.9 ± 14.88; P < 0.05). The accuracy of diagnosing tumor laterality with the interpetrosal S1P and ACTH ratios and the combination of the two was 64%, 56% and 73%, respectively. The receiver operating characteristic curve analysis revealed that the combination of interpetrosal S1P and ACTH ratios, as a predictor of tumor laterality, exhibited a sensitivity of 81.82% and a specificity of 75%, with an area under the curve value of 84.09%. Moreover, we observed that a high interpetrosal S1P ratio was associated with nonremission after surgery. Correlation analyses demonstrated that the interpetrosal S1P ratio was associated with preoperative follicle-stimulating hormone (FSH), luteinizing hormone (LH), and postoperative ACTH 8 am levels (P < 0.05).
Our study demonstrated a significant association between the interpetrosal S1P ratio and tumor laterality, as well as postoperative remission in CD, suggesting that the interpetrosal S1P ratio could serve as a valuable biomarker in clinical practice.
We employed bilateral inferior petrosal sinus sampling (BIPSS), which is considered the gold standard for diagnosing pituitary sources of CD, to obtain blood samples and explore the clinical predictive value of the S1P concentration ratio in determining tumor laterality and postoperative remission. We evaluated 50 samples from 25 patients who underwent BIPSS to measure S1P levels in the inferior petrosal sinuses bilaterally.
Serum S1P levels in patients with CD were significantly higher on the adenoma side of the inferior petrosal sinus than on the nonadenoma side (397.7 ± 15.4 vs. 261.9 ± 14.88; P < 0.05). The accuracy of diagnosing tumor laterality with the interpetrosal S1P and ACTH ratios and the combination of the two was 64%, 56% and 73%, respectively. The receiver operating characteristic curve analysis revealed that the combination of interpetrosal S1P and ACTH ratios, as a predictor of tumor laterality, exhibited a sensitivity of 81.82% and a specificity of 75%, with an area under the curve value of 84.09%. Moreover, we observed that a high interpetrosal S1P ratio was associated with nonremission after surgery. Correlation analyses demonstrated that the interpetrosal S1P ratio was associated with preoperative follicle-stimulating hormone (FSH), luteinizing hormone (LH), and postoperative ACTH 8 am levels (P < 0.05).
Our study demonstrated a significant association between the interpetrosal S1P ratio and tumor laterality, as well as postoperative remission in CD, suggesting that the interpetrosal S1P ratio could serve as a valuable biomarker in clinical practice.
摘要：
■库欣病（CD）由于缺乏可靠的生物标志物来预测肿瘤定位或术后临床结果，在其治疗中提出了重大挑战。鞘氨醇-1-磷酸（S1P）已被证明可以增加皮质醇的生物合成，并受到促肾上腺皮质激素（ACTH）的调节。
■我们采用了双侧岩下窦采样（BIPSS），这被认为是诊断脑垂体来源CD的黄金标准，采集血样，探讨S1P浓度比值对判断肿瘤偏侧性和术后缓解的临床预测价值。我们评估了25例接受BIPSS的患者的50个样本，以测量双侧岩下窦的S1P水平。
■CD患者的血清S1P水平在下岩窦腺瘤侧明显高于非腺瘤侧（397.7±15.4vs.261.9±14.88；P<0.05）。岩间S1P和ACTH比值及两者联合诊断肿瘤侧向性的准确率为64%,56%和73%，分别。接收器工作特性曲线分析表明，岩间S1P和ACTH比值的组合，作为肿瘤侧向性的预测因子，表现出81.82%的灵敏度和75%的特异性，曲线下面积值为84.09%。此外，我们观察到较高的岩间S1P比率与术后未缓解相关.相关分析表明，岩间S1P比值与术前卵泡刺激素（FSH）相关，黄体生成素(LH),术后ACTH8am水平(P<0.05)。
■我们的研究表明，岩间S1P比率与肿瘤侧向性之间存在显着关联，以及CD术后缓解，提示岩间S1P比值可作为临床实践中一个有价值的生物标志物。
■我们采用了双侧岩下窦采样（BIPSS），这被认为是诊断脑垂体来源CD的黄金标准，采集血样，探讨S1P浓度比值对判断肿瘤偏侧性和术后缓解的临床预测价值。我们评估了25例接受BIPSS的患者的50个样本，以测量双侧岩下窦的S1P水平。
■CD患者的血清S1P水平在下岩窦腺瘤侧明显高于非腺瘤侧（397.7±15.4vs.261.9±14.88；P<0.05）。岩间S1P和ACTH比值及两者联合诊断肿瘤侧向性的准确率为64%,56%和73%，分别。接收器工作特性曲线分析表明，岩间S1P和ACTH比值的组合，作为肿瘤侧向性的预测因子，表现出81.82%的灵敏度和75%的特异性，曲线下面积值为84.09%。此外，我们观察到较高的岩间S1P比率与术后未缓解相关.相关分析表明，岩间S1P比值与术前卵泡刺激素（FSH）相关，黄体生成素(LH),术后ACTH8am水平(P<0.05)。
■我们的研究表明，岩间S1P比率与肿瘤侧向性之间存在显着关联，以及CD术后缓解，提示岩间S1P比值可作为临床实践中一个有价值的生物标志物。
