垂体生长激素腺瘤经蝶手术预后的影响因素分析

Analysis of factors related to prognoses in patients with growth hormone-secreting pituitary adenomas after transsphenoidal surgery

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<1.0μg/L或OGTT-GH谷值<0.4μg/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≤30μg/L患者术后缓解率(72.5%)明显高于术前血清GH>30μg/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>1.16μg/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>30μg/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<1.16μg/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。

ObjectiveTo investigate factors affecting postoperative remission in patients with growth hormone（GH）-secretingpituitary adenomas.MethodsThe clinical data of 60 patients with acromegaly, who underwent transsphenoid surgery in our center wereanalyzed 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）. Coxproportional hazards model showed that the size and invasiveness of the adenomas, preoperative serum GH level were the factorsaffecting the postoperative remission. The rate of decrease in the serum GH level was significantly lower in the postoperative remissionpatients than that in the patients without postoperative remission immediately after the removal of the adenomas（P〈0.05）. The serum GHlevel was significantly lower in the postoperative remission patients than that in the patients without postoperative remission 1 day afterthe surgery.ConclusionHigher preoperative GH levels, marcroadenomas and invasive adenomas suggest the bad prognoses in thepatients with GH-secreting pituitary adenomas. The rate of decrease in the serum GH levels immediately after the removal of theadenomas and the serum GH level 1 day after the surgery may be helpful to predicting the prognoses in the patients with GH-secretingpituitary adenomas.