神经内镜经鼻蝶窦入路手术治疗垂体生长激素细胞腺瘤后生化缓解的影响因素分析

Analysis of influencing factors of biochemical remission after neuroendoscopic transnasosphenoidal surgery for growth hormone-secreting pituitary adenoma

目的探讨神经内镜经鼻蝶窦入路手术治疗垂体生长激素(GH)细胞腺瘤后生化缓解的影响因素。方法回顾性分析福建医科大学附属第一医院神经外科2017年1月至2021年3月采用神经内镜经鼻蝶窦入路行肿瘤切除术的80例垂体GH细胞腺瘤患者的临床资料。所有患者手术前、后均行全面的内分泌功能评估。术后根据2021版《中国肢端肥大症诊治共识》中的生化缓解标准判断患者是否达到生化缓解,并将其分为生化缓解组和生化未缓解组。比较两组的年龄、性别、病程、术前GH、胰岛素样生长因子1(IGF-1)、影像学评估结果、术中所见及病理学指标,将其中差异有统计学意义的因素纳入多因素logistic回归分析,判断影响垂体GH细胞腺瘤患者术后生化缓解的危险因素。结果80例患者术后GH中位数为6.2μg/L(0.4~128.2μg/L)(1μg/L=0.047 nmol/L),IGF-1为(407.5±191.4)ng/ml(122.9~804.6 ng/ml),均较术前明显降低[术前GH中位数:52.3μg/L(2.8~456.4μg/L)、IGF-1:(693.6±294.2)ng/ml(163.8~1970.0 ng/ml),均P<0.001]。根据2021版的生化缓解标准,47例患者达到生化缓解(生化缓解组),另33例未达到(生化未缓解组)。与生化未缓解组比较,生化缓解组患者的术前GH水平低,肿瘤最大径>3.0 cm、Knosp分级为3、4级、Hardy分期为E期的患者占比均低(均P<0.05)。多因素logistic回归分析结果显示,术前GH水平(OR=1.033,95%CI:1.001~1.066,P=0.046)和Knosp分级(OR=14.498,95%CI:3.534~59.317,P<0.001)是影响患者术后生化缓解的危险因素。结论术前GH水平越低、Knosp分级越低的垂体GH细胞腺瘤患者行神经内镜经鼻蝶窦入路肿瘤切除术后易达到生化缓解。

Objective To explore the influencing factors of biochemical remission after neuroen-doscopic transnasosphenoidal surgery for growth hormone(GH)-secreting pituitary adenoma.Methods A retrospective analysis was conducted on the clinical data of 80 patients with GH-secreting pituitary adenoma who underwent tumor resection by neuroendoscopic transnasosphenoidal approach from January 2017 to March 2021 at the Department of Neurosurgery,the First Affiliated Hospital of Fujian Medical University.All patients underwent a comprehensive endocrine assessment before and after surgery.After surgery,according to the biochemical remission criteria in the 2021 edition of"Consensus on Diagnosis and Treatment of Acromegaly in China",all patients were divided into biochemical remission group and biochemical non-remission group,and the age,gender,course of disease,preoperative GH and insulin-like growth factor 1(IGF-1),imaging evaluation results,intraoperative findings and pathological indicators were compared between the two groups.Factors with statistically significant differences among them were included in the multivariate logistic regression analysis to determine the risk factors affecting postoperative biochemical remission of patients with GH-secreting pituitary adenoma.Results Postoperative endocrine evaluation results showed that median postoperative GH level of 80 patients was 6.21μg/L(0.4-128.2μg/L)(1μg/L=0.047 nmol/L),and postoperative IGF-1 level was 407.5±191.4 ng/ml(122.9-804.6 ng/ml).Both were significantly lower than those before operation[both P<0.001;median preoperative GH level:52.3μg/L(2.8-456.4μg/L);preoperative IGF-1 level:693.6±294.2 ng/ml(163.8-1970.0 ng/ml)].According to the biochemical remission standard(2021 edition),47 cases achieved biochemical remission(biochemical remission group),and the other 33 cases failed to achieve biochemical remission(biochemical non-remission group).Compared with the biochemical non-remission group,the biochemical remission group had lower preoperative GH level and lower proportions of patients with maximum tumor diameter>3.0 cm,Knosp grade 3,4 and Hardy stage E(all P<0.05).The results of multivariate logistic regression showed that preoperative GH level(OR=1.033,95%CI:1.001-1.066,P=0.046)and Knosp grade(OR=14.498,95%CI:3.534-59.317,P<0.001)were risk factors that affected the postoperative biochemical remission of patients with GH-secreting pituitary adenoma.Conclusion Patients with GH-secreting pituitary adenoma with lower preoperative GH level and lower Knosp grade are more likely to achieve biochemical remission after endoscopic transnasosphenoidal surgery.