Home Waking Salivary Cortisone to Screen for Adrenal Insufficiency
Home Waking Salivary Cortisone to Screen for Adrenal Insufficiency
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首页 唤醒唾液可的松来筛查肾上腺功能不全
DOI：
10.1056/evidoa2200182
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Debono M
中科院分区：
文献类型：
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作者：
Debono M
背景在世界范围内，由于使用抗炎糖皮质激素和阿片类药物以及传染病导致肾上腺抑制，成人和儿童面临肾上腺功能不全的风险。促肾上腺皮质激素（ACTH）刺激试验是诊断肾上腺功能不全的参考标准，但需要就诊和静脉切开术。唾液可的松反映了游离的血清皮质醇，样品可以在家中采集并邮寄到实验室。我们测试了在家清醒时唾液可的松水平是否可用于筛查肾上腺功能不全。方法对肾上腺功能不全高风险患者进行了前瞻性诊断准确性研究。患者在醒来时收集家庭唾液样本，然后前往临床机构进行 ACTH 刺激测试。通过液相色谱-串联质谱法测量唾液可的松。计算受试者工作特征曲线，并计算阳性和阴性预测值。结果纳入220名患者。通过 ACTH 刺激试验测得，肾上腺功能不全的患病率为 44%。清醒时唾液可的松作为肾上腺功能不全预测因子的受试者工作特征曲线下面积为 0.95（95% 置信区间 [CI]，0.92 至 0.97）。确保至少 95% 敏感性和特异性的临界值分别给出 96% 的阴性预测值（95% CI，90 至 99）和 95% 的阳性预测值（95% CI，87 至 99），以排除和确认肾上腺功能不全。 70% 的参与者清醒时唾液可的松数据提供的信息与 ACTH 刺激测试的信息类似。 83% 的患者更喜欢在家采集唾液而不是到诊所就诊。 结论 在家清醒时唾液可的松取样对于诊断肾上腺功能不全的准确性与标准 ACTH 刺激试验的准确性相似。患者发现在家测试比医院测试更方便。 （由国家健康研究所资助。）
BackgroundWorldwide, adults and children are at risk of adrenal insufficiency as a result of adrenal suppression from use of anti-inflammatory glucocorticoids and opiates, as well as infectious diseases. The adrenocorticotropin (ACTH) stimulation test is the reference standard for diagnosis of adrenal insufficiency but requires clinic attendance and venesection. Salivary cortisone reflects free serum cortisol, and samples can be collected at home and posted to a laboratory. We tested whether home waking salivary cortisone level could be used to screen for adrenal insufficiency.MethodsA prospective, diagnostic accuracy study was performed in patients at high risk of adrenal insufficiency. Patients collected a home salivary sample on waking and then attended the clinical facility for an ACTH stimulation test. Salivary cortisone was measured by liquid chromatography–tandem mass spectrometry. Receiver-operating characteristic curves were computed, and positive and negative predictive values were calculated.ResultsTwo hundred twenty patients were recruited. As measured by an ACTH stimulation test, the prevalence of adrenal insufficiency was 44%. The area under the receiver-operating characteristic curve for waking salivary cortisone as a predictor of adrenal insufficiency was 0.95 (95% confidence interval [CI], 0.92 to 0.97). Cutoffs to ensure a minimum of 95% sensitivity and specificity gave a negative predictive value of 96% (95% CI, 90 to 99) and a positive predictive value of 95% (95% CI, 87 to 99) to exclude and confirm adrenal insufficiency, respectively. Waking salivary cortisone data provided information similar to that of an ACTH stimulation test in 70% of participants. Eighty-three percent of patients preferred home salivary collection to clinic attendance.ConclusionsHome waking salivary cortisone sampling has accuracy for the diagnosis of adrenal insufficiency similar to that of a standard ACTH stimulation test. Patients found the at-home test to be more convenient than the hospital-based test. (Funded by the National Institute for Health Research.)