淋巴细胞性垂体炎32例临床分析

Clinical analysis of 32 cases of lymphocytic hypophysis

目的总结并研究淋巴细胞性垂体炎(LyH)临床特点、诊治及预后,以期提高诊疗水平。方法回顾性分析2013年8月至2018年8月于我院神经外科就诊的32例LyH患者的临床资料、诊疗预后。结果本研究纳入32例LyH患者的发病中位年龄为31岁,男7例,女25例。25例患者应用糖皮质激素治疗后21例症状明显改善,复查MRI显示垂体明显缩小,垂体柄变细;2例无明显改善者加用免疫抑制剂治疗后症状缓解;1例患者予以去氨加压素对症治疗,尿崩症状改善,垂体柄治疗前后无明显变化。6例患者予以手术治疗,并术前或术后予以激素治疗,5例患者视力、视野明显改善,1例无明显善。随访1~2年后,7例激素治疗的患者复发,6例手术治疗患者随访结束时未出现复发,其中3例需长期予以靶腺激素替代治疗。结论 LyH临床表现具有多样性,应结合影像学资料予以鉴别。多学科会诊,个体化选择治疗方案,以激素治疗及手术治疗为主,两种治疗方案均可取得较为满意疗效。

Objective To summarize and study the clinical features,diagnosis,treatment and prognosis of lymphocytic hypophysitis(LyH)and to improve the diagnosis and treatment of LyH.Methods The clinical data and prognosis of 32 patients with LyH from August 2013 to August 2018 were analyzed retrospectively.Results The median age of the 32 patients(7 males and 25 females)with LyH was 31 years.Twenty-one patients treated with glucocorticoid were improved significantly;MRI showed that pituitary gland was significantly reduced and the stalk of pituitary gland became thinner.Two patients without obvious improvement were treated with immunosuppressive agents.One patient was treated with desmopressin and diabetes insipidus improved but stalk of pituitary gland showed no change.Six patients were treated with surgery and glucocorticoid was used before and after the operation and visual acuity and visual field of 5 patients were improved significantly,but 1 was not improved significantly.After the follow-up of 1 to 2 years,7 patients with glucocorticoid therapy were relapsed but 6 with surgical treatment at the end of follow-up not,3 of which need long-term target hormone replacement therapy.Conclusions Clinical manifestations of LyH are diverse and should be differentiated by imaging.Multidisciplinary diagnosis and individualized treatment are conducive to satisfactory results.Glucocorticoid therapy and surgical treatment are the main treatment methods.