[1]傅 炜 卞留贯 陈 晓 钟志宏 孙昱皓 孙青芳.垂体生长激素腺瘤经蝶手术预后的影响因素分析[J].中国临床神经外科杂志,2015,(10):584-587.[doi:10.13798/j.issn.1009-153X.2015.10.003]
 FU Wei,BIAN Liu-guan,CHEN Xiao,et al.Analysis of factors related to prognoses in patients with growth hormone-secreting pituitary adenomas after transsphenoidal surgery[J].,2015,(10):584-587.[doi:10.13798/j.issn.1009-153X.2015.10.003]
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垂体生长激素腺瘤经蝶手术预后的影响因素分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2015年10期
页码:
584-587
栏目:
论著
出版日期:
2015-10-30

文章信息/Info

Title:
Analysis of factors related to prognoses in patients with growth hormone-secreting pituitary adenomas after transsphenoidal surgery
文章编号:
1009-153X(2015)10-0584-04
作者:
傅 炜 卞留贯 陈 晓 钟志宏 孙昱皓 孙青芳
200025 上海,上海交通大学医学院附属瑞金医院神经外科
通讯作者:卞留贯,E-mail:rj11118@163.com
Author(s):
FU Wei BIAN Liu-guan CHEN Xiao ZHONG Zhi-hong SUN Yu-hao SUN Qing-fang.
Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
关键词:
肢端肥大症生长激素腺瘤经蝶手术缓解影响因素
Keywords:
Acromegaly Growth hormone-secreting pituitary adenoma Transsphenoid surgery Remission Factor
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2015.10.003
文献标志码:
A
摘要:
目的 探讨垂体生长激素(GH)腺瘤经蝶手术预后的影响因素。方法 回顾性分析60例经蝶手术治疗垂体GH腺瘤患者的临床资料,术后缓解标准为血清IGF-1水平在年龄校正后的正常范围,以及随机血清GH水平<1.0 μg/L或OGTT-GH谷值<0.4 μg/L。结果 术后总缓解率为60%(36/60)。微腺瘤术后缓解率(90.0%)明显高于大腺瘤(46.0%;P<0.05),非侵袭性腺瘤术后缓解率(73.2%)明显高于侵袭性腺瘤(31.6%;P<0.05),术前血清GH≤30 μg/L患者术后缓解率(72.5%)明显高于术前血清GH>30 μg/L患者(35.0%;P<0.05)。术后缓解患者术后1 d血清GH水平明显低于未缓解患者(P<0.05),根据受试者工作特征(ROC)曲线,术前血清GH水平>1.16 μg/L时,判断术后不缓解的敏感度为80.6%,特异度为100%。术后缓解患者术中GH下降程度明显低于未缓解患者(P<0.05),根据ROC曲线,术中血清GH水平下降程度<40%时,判断术后不缓解的敏感度为79.4%,特异度为61.9%。结论 术前GH水平>30 μg/L、大腺瘤、侵袭性腺瘤是垂体GH腺瘤术后缓解的不良因素;术后1 d血清GH水平<1.16 μg/L对术后缓解具有良好的预测效果;术中血清GH下降程度>40%对术后缓解具有一定的预测效果。
Abstract:
Objective To investigate factors affecting postoperative remission in patients with growth hormone(GH)-secreting pituitary adenomas. Methods The clinical data of 60 patients with acromegaly, who underwent transsphenoid surgery in our center were analyzed retrospectively. The factors related to the postoperative remission were analyzed by the Cox proportional hazards model. Results Of 60 patients with GH-secreting pituitary adenomas, 36 received postoperative biochemical remission and 24 not. The remission rate (90.0%, 9/10) was significantly higher in the patients with microadenomas than that (46.0%, 23/50) in the patients with macroadenomas (P<0.05). The remission rate (73.2%, 30/41) was significantly higher in the patients with non-invasive adenomas than that (31.6%, 6/19) in the patients with invasive adenomas (P<0.05). The remission rate (72.5%, 29/40) was significantly higher in the patients with pre- operative serum GH level ≤30 μg/L than that (35.0%, 7/20) in the patients with preoperative serum GH level >30 μg/L (P<0.05). Cox proportional hazards model showed that the size and invasiveness of the adenomas, preoperative serum GH level were the factors affecting the postoperative remission. The rate of decrease in the serum GH level was significantly lower in the postoperative remission patients than that in the patients without postoperative remission immediately after the removal of the adenomas (P<0.05). The serum GH level was significantly lower in the postoperative remission patients than that in the patients without postoperative remission 1 day after the surgery. Conclusion Higher preoperative GH levels, marcroadenomas and invasive adenomas suggest the bad prognoses in the patients with GH-secreting pituitary adenomas. The rate of decrease in the serum GH levels immediately after the removal of the adenomas and the serum GH level 1 day after the surgery may be helpful to predicting the prognoses in the patients with GH-secreting pituitary adenomas.

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备注/Memo

备注/Memo:
基金项目:国家卫计委国家临床重点专科建设项目
更新日期/Last Update: 2015-10-30