垂体微腺瘤的临床内分泌与病理免疫组化类型相关性分析

The relative analysis of clinical endocrine features and pathological types of pituitary microadenomas

目的 探讨垂体微腺瘤临床症状、内分泌检查和病理类型之间的关系,以期更好地指导临床诊断和选择治疗方法.方法 收集2007年1月至2009年6月经手术切除的94例垂体微腺瘤患者的临床资料、内分泌检查结果及病理诊断.按病理免疫组化结果分为免疫组化阳性组和阴性组.运用χ2检验进行数据分析.结果 本组病例中出现内分泌症状86例（91.5%）,免疫组化阳性组发生率（85/92,92.4%）较免疫组化阴性组发生率（1/2,50.0%）增高（P＜0.05）,内分泌症状与免疫组化结果相符合.激素过多症状与免疫组化结果相一致的占71.7%,其中泌乳素（PRL）阳性出现闭经、溢乳或性功能低下占8 8.9%,生长激素（GH）阳性出现巨人症或肢端肥大症的占28.1%.内分泌检查激素增高与免疫组化结果相一致的占69.0%,其中PRL阳性出现血清PRL增高的占87.7%,GH阳性出现血清GH增高的占21.9%.结论 垂体微腺瘤患者的临床表现及内分泌检查能很好地与病理类型相联系,可以作为功能性垂体微腺瘤临床诊断的主要手段.

Objectives To study the relationship between the clinical presentation, endocrinal findings and pathological types in patients with pituitary microadenomas, so as to improve the accuracy of clinical diagnosis and choose the best therapy strategy before the operation. Methods From January 2007 to June 2009, the clinical data of 94 patients who were surgerically removed pituitary microadenomas were obtained, including the clinical presentation, endocrinal findings and pathological diagnosis. The analysis was accomplished with Chi-square test. Results Hormonal symptoms were found in 86 patients （91.5%） ,it occurred more frequently in immunopositive patients（85/92,92. 4% ） than in immunonegative patients（ 1/2,50. 0% ） （ P 〈 0. 05 ）. The coincidence of hormonal symptoms and immunohistochemistry diagnosis was 71.7% ;88.9% patients had the symptoms of amenorrhea, galactorrhea and sexual function diseases in prolactin（PRL） positive group and 28. 1% patients had the symptoms of gigantism or acromegaly in growth hormone（GH） positive group. The coincidence of endocrinal findings and immunohistochemistry diagnosis was 69. 0% ;87.7% patients had high level of blood PRL in PRL positive group and 21.9% patients had high level of blood GH in GH positive group. Conclusions There is an obvious relationship between the clinical presentation, endocrinal findings and pathological diagnosis in patients with pituitary microadenomas,which may contribute to the clinical diagnosis and treatment of pituitary secreting microadenomas.