动脉瘤性蛛网膜下腔出血后急性期并发腺垂体功能减退的临床分析

Hypopituitorism happened in patients with aneurysmal subarachnoid haemorrhage in acute stage

目的探讨动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid haemorrhage,aSAH)后腺垂体功能减退发生的危险因素和对预后的影响。方法回顾性分析吉林大学中日联谊医院神经外科2017年9月至2018年9月收治的确诊为aSAH并于发病后3~7 d进行腺垂体功能评估的患者。共72例纳入研究,男31例,女41例,平均年龄50.1岁,范围为36~71岁。入院时WFNS分级:Ⅰ级24例、Ⅱ级20例,Ⅲ级15例、Ⅳ级10例、Ⅴ级3例。Fisher分级:2级21例,3级38例、4级13例。13例合并有急性脑积水。动脉瘤位于Willis环56例,非Willis环动脉瘤16例。开颅夹闭37例,介入栓塞35例。依据腺垂体功能的情况,将72例分为腺垂体功能减退组(34例)和腺垂体功能正常组(38例)。中枢性肾上腺皮质功能减退的患者给予氢化可的松替代治疗,垂体甲状腺轴功能减退的患者给予左甲状腺素替代治疗。3个月时进行随访,以GOS评分评价患者恢复情况。采用SPSS 18.0软件进行分析比较两组的临床特征及预后。正态分布的计量资料组间比较采用t检验,计数资料组间比较采用χ^(2)检验。P<0.05为差异有统计学意义。结果34例并发腺垂体功能减退,腺垂体功能减退的发生率为47.2%。腺垂体功能减退的发生和年龄、性别、合并脑积水情况差异无统计学意义(t=0.792,P=0.430;χ^(2)=0.387,P=0.526;χ^(2)=0.279,P=0.597)。WFNS分级≥Ⅳ级、Fisher分级4级、动脉瘤位于Willis环、开颅夹闭的患者更易发生腺垂体功能减退(χ^(2)=4.726,P=0.039;χ^(2)=5.615,P=0.018;χ^(2)=4.298,P=0.042;χ^(2)=20.251,P<0.001)。3个月随访时腺垂体功能减退组恢复良好(GOS≥4分)的比例低于腺垂体功能正常组(χ^(2)=4.188,P=0.048)。结论WFNS分级≥Ⅳ级、Fisher分级4级、Willis环动脉瘤和开颅夹闭是急性期发生腺垂体功能减退的危险因素。急性期发生的腺垂体功能减退影响aSAH患者的预后,其中肾上腺皮质功能减退和甲状腺功能减退应积极治疗。

Objective To explore the risk factors of hypopituitorism after aneurysmal subarachnoid haemorrhage(aSAH)in the acute phase and analysis the effect of hypopituitorism on prognosis.Methods Patients with aSAH that were diagnosed and treated in China-Japan Union Hospital from Sep.2017 to Sep.2018 and undergoing pituitary function evaluation within 3 to 7 days were retrospectively analyzed.72 patients were enrolled,including 31 males and 41 females.The average age was 50.1 years old(36-71).The WFNS gradings wereⅠ,24;Ⅱ,20;Ⅲ,15;Ⅳ,10;Ⅴ,3.The Fisher gradings were 2,21;3,38;4,13.Acute hydrocephalus happened in 13 cases.Aneurysm located in the Willis circle in 56 cases and not in the Willis circle in 16 cases.37 cases were treated by microsurgical clipped and 35 cases were treated by embolism.Patients with hypocortisolism were treated by hydrocortisone replacement,and patients with hypothyroidism were given levothyroxine replacement therapy.Patients were followed up at 3 months and their recovery was evaluated by GOS score.Results Hypopituitorism was detected in 34 patients;the incidence of hypopituitorism was 47.2%.There was no significant correlation between the occurrence of hypopituitorism and age,gender,and hydrocephalus(P>0.05).Patients with WFNS grade≥Ⅳ,Fisher grade 4,aneurysm located in the Willis circle,and treated by clipping were more likely to undergo hypopituitorism.The proportion of patients with good recovery(GOS≥4)in the hypopituitorism group was smaller than that in the normal pituitary function group at the 3-month follow-up.Conclusions Patients with WFNS grade≥Ⅳ,Fisher grade 4,aneurysm located in the Willis circle,and treated by clipping are more likely to undergo hypopituitorism.Hypopituitorism in acute stage affects the prognosis of aSAH patients.Patients with hypocortisolism and hypothyroidism should be treated actively.