基于病理、影像及临床表现的垂体卒中的临床分型探讨

An investigation on clinical typing of pituitary apoplexy based on the analysis of pathologic, image, and clinical manifestations

将主要根据术后病理诊断的61例垂体卒中（pituitary apoplexy, PA）患者分为四型：仅有病理报告为垂体出血而 MRI 阴性的“隐匿型”,病理和 MRI 均阳性而临床无明显卒中表现的“无症状型”,病理和 MRI 阳性并有明显卒中症状2周以上的“亚急性型”,以及病理和 MRI 阳性同时卒中症状小于或等于2周的“急性型”。分析四型的基础病变、急性和慢性临床症状、内分泌功能改变和 MRI 表现的差别。结果发现,在总体患者,占位效应症状主要为头痛（60.7%）、视力下降（55.7%）、呕吐（21.3%）以及头昏（14.8%）。卒中相关症状包括剧烈头痛（24.6%）、视力剧降（29.5%）以及眼睑下垂或复视（9.83%）。隐匿型、无症状性、亚急性型和急性型分别为15（24.6%）、9（14.8%）、19（31.1%）和18（29.5%）例。随着分型的病情加重,年龄、占位症状首发有逐渐增加趋势（均 P〈0.05）,慢性病程有减少的趋势（P〈0.05）；两种临床型急性占位症状明显高于两种非临床型（P〈0.01）。非临床型功能性垂体瘤明显多于临床型（P〈0.01）,后者的无功能瘤则明显高于前者（P〈0.01）。垂体-靶腺轴功能受损随分型加重有逐渐增加趋势（P〈0.01）。本研究提供了一种简便的 PA 分型,以涵盖 PA 的各种表型的变化。并发现四个类型从轻到重在年龄、功能瘤构成等方面有明显趋势性差异。

[Summary] Sixty-one patients suffering from pituitary apoplexy（ PA） were mainly diagnosed according to pathologic findings, and were collected from case record, pathology, and MRI databases. They were classified into 4 types according to the clinical condition： the insidious type was characterized with only positive pathological findings;the asymptomatic type had both positive pathologic and MRI findings; the subacute type had PA associated symptoms longer than 2 weeks; and the acute type had PA associated symptoms for 2 weeks or less. The latter 2 types had positive pathological and MRI findings additionally. The basic lesions, acute or chronic symptoms, endocrinopathies and MRI findings were compared among 4 types. Results showed as followed. In all patients, there were headache（60. 7% ）, blurred vision（55. 7% ）, vomiting（21. 3% ）, and dizziness（14. 8% ）. Apoplexy associated symptoms comprised severe headache （24. 6% ）, rapid vision loss （29. 5% ）, and blepharopotosis or diplopia （9. 83% ）. Insidious, asymptomatic, subacute, and acute types were composed of 15 （24. 6% ）, 9 （14. 8% ）, 19 （31. 1% ）, and 18 （29. 5% ） cases, respectively. Aging and intracranial space-occupying symptoms as first complaint showed increasing trend from mild to severe types（both P〈0. 05）, while in chronic course it showed decreasing trend（P〈0. 05）. Acute massive symptoms（P〈0. 01）, and non-functional tumor（P〈0. 01） in the 2 clinical types were much more frequent than in the two mild types. Half or more pituitary-target glands showed impaired functions in each type, and the impairment showed increasing trend through mild to severe types（P〈0. 01）. The present study provided a brief typing system in order to expand PA concept to a wider span covering various conditions. Some differences in tumor composition and endocrinopathies existed among the four types.