神经内镜经鼻蝶入路治疗伴肢端肥大症垂体肿瘤生化指标缓解因素分析

A risk factors analysis on biochemical remission of pituitary tumor patients with acromegaly treated by the endoscopic endonasal surgery

目的探讨影响神经内镜经鼻蝶入路手术治疗伴肢端肥大症垂体肿瘤患者术后生化指标缓解的因素。方法回顾性分析2013年8月至2016年11月神经内镜下经鼻蝶窦入路手术治疗的61例肢端肥大症患者的临床资料。患者均行全面内分泌学检查,包括空腹或随机生长激素(growth hormone,GH)水平、口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)GH谷值水平和胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)。临床资料包括患者性别,年龄,术前GH值,术前IGF-1值,肿瘤是否侵犯颈内动脉下间隙,肿瘤包绕颈内动脉角度≥/<135°,Knosp分级,Hardy分级,肿瘤体积等。并对上述因素进行单因素分析和多因素Logistic回归分析。结果61例接受神经内镜下经鼻蝶垂体肿瘤切除术的肢端肥大症患者中,术后内分泌缓解32例(52.5%)。单因素分析提示:术前GH,颈内动脉包绕角度

Objective To study the risk factors of the biochemical remission of pituitary tumor patients with acromegaly treated by the endoscopic endonasal surgery. Methods A retrospective analysis of clinical data was conducted on 61 cases acromegaly patients underwent endoscopic endonasal surgery between August 2013- November 2016. Endocrinology tests were performed in all patients, including the fasting/random GH （growth hormone, GH） level, Nadir GH during OGTT （oral glucose tolerance test, OGT]＇）, and IGF-1 （ insulin-like growth factor-1 ,IGF-1 ）. The clinical data included gender, age, preoperative GH value, preoperative IGF-1 value, tumor invasion of the inferface space of internal carotid artery （ICA）,tumor surrounding angle of internal carotid artery （≥/〈135°）, Knosp grade, Hardy grade, and tumor volume . Univariate analysis and multivariate Logistic retrospective analysis were used to analyze the association between above-mentioned factors and the occurrence of biochemical remission. Results There were 52.5% （32/61）patients achieving biochemical remission. Univariate analysis showed significant differences between patients with and without biochemical remission in preoperative GH value, tumor surrounding angle of internal carotid artery （〈/≥135°）and Knosp grade （P〈0.05）. The Logistic regression analysis showed that preoperative GH value, tumor surrounding angle of internal carotid artery （〈/≥ 135°）were risk factors concerning about the biochemical remission in patients underwent endoscopic endonasal surgery. （P〈0.05）. Conclusion Tumor surrounding angle of internal carotid artery （≥135°）is independent risk factors, while the preoperative GH value is a risk predictor of biochemical remission after endoscopic endonasal surgery in acromegaly.