库欣病经蝶入路肿瘤切除术后复发的影响因素分析

Analysis of the influencing factors of the recurrence of Cushing′s disease after transsphenoidal surgery

目的探讨库欣病患者经蝶入路肿瘤切除术后复发的影响因素。方法回顾性分析2013年5月至2020年7月郑州大学第一附属医院神经外科采用显微镜或神经内镜经蝶入路手术治疗且术后达到缓解标准的164例库欣病患者的临床资料。收集患者的性别、年龄、吸烟史、饮酒史、高血压病史、糖尿病史、脂代谢异常史、入院时收缩压和舒张压、术前体质量指数(BMI)、影像学检查结果(肿瘤直径、是否向鞍上进展以及是否具有侵袭性)、手术方式、是否为二次手术以及随访时间。收集手术前和手术后第1天清晨的血促肾上腺皮质激素(ACTH)、皮质醇以及术前24 h尿游离皮质醇水平。将患者术后已达到缓解标准,而随访期间再次出现典型的临床症状和高皮质醇血症定义为复发。根据有无复发分为复发组(n=25)和未复发组(n=139)。比较两组患者的临床资料。采用多因素logistic回归分析判断术后复发的影响因素。结果与未复发组比较,复发组术前有脂代谢异常史患者的占比、术前BMI、术前清晨血ACTH水平、垂体大腺瘤者占比、侵袭性肿瘤占比、术后第1天清晨血ACTH和皮质醇水平均较高,而随访时间较短,差异均具有统计学意义(均P<0.05);两组患者其他指标的差异均无统计学意义(均P>0.05)。多因素logistic回归分析结果显示,术前BMI较高(OR=1.39,95%CI:1.012~1.910,P=0.042)以及术后第1天清晨血ACTH(OR=1.02,95%CI:1.002~1.037,P=0.027)和皮质醇水平较高(OR=1.01,95%CI:1.003~1.020,P=0.010)均是术后复发的危险因素。结论术前BMI较高以及经蝶入路肿瘤切除术后第1天清晨血ACTH和皮质醇水平较高的库欣病患者,术后复发风险更高。

Objective To explore the influencing factors of the recurrence of Cushing′s disease(CD)after transsphenoidal surgery.Methods A retrospective analysis was conducted on the clinical data of 164 patients with CD who were treated with microscopy or neuroendoscopic transsphenoidal surgery from May 2013 to July 2020 in the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University and reached remission standards after surgery.We collected the data including the patient′s gender,age,smoking history,drinking history,history of hypertension,history of diabetes,history of abnormal lipid metabolism,systolic and diastolic blood pressures at admission,preoperative body mass index(BMI),imaging examination results(tumor diameter,saddle progression and invasiveness),the operation method,whether it was a second operation,and the follow-up time.The serum adrenocorticotropic hormone(ACTH),cortisol and 24 h urinary free cortisol levels on the preoperative and postoperative day one(POD1)mornings were documented.Recurrence was defined as the presence of typical clinical symptoms and hypercortisolemia during the follow-up period after postoperative remission.According to the presence or absence of recurrence,the patients were divided into recurrence group(n=25)and non-recurrence group(n=139).We compared the clinical data of the two groups of patients.Multivariate logistic regression analysis was used to determine the influencing factors of postoperative recurrence.Results Compared with those in the non-recurrence group,the patients in the recurrence group had significantly higher proportion of dyslipidemia,higher preoperative BMI and preoperative morning serum ACTH level,higher proportions of macroadenoma and invasive adenomas,higher POD1 morning serum ACTH and cortisol levels,and shorter follow-up time(all P<0.05).There was no statistical significance in other indicators between the two groups of CD patients(all P>0.05).Multivariate logistic regression analysis indicated that higher preoperative BMI(OR=1.39,95%CI:1.012-1.910,P=0.042),higher POD1 morning serum ACTH(OR=1.02,95%CI:1.002-1.037,P=0.027)and cortisol levels(OR=1.01,95%CI:1.003-1.020,P=0.010)were risk factors for postoperative recurrence.Conclusion Patients with CD who have a higher preoperative BMI and higher POD1 morning serum ACTH and cortisol levels after transsphenoidal tumor resection seem to have a higher risk of postoperative recurrence.