成人腺垂体功能减退症患者临床特征及并发感染的危险因素

Clinical characteristics and risk factors for concurrent infection in adult patients with hypopituitarism

目的探讨成人腺垂体功能减退症(HP)患者的临床特征及并发感染的危险因素。方法收集2016年10月至2020年8月在阜阳市人民医院确诊为HP患者的临床资料,依据是否合并感染,分为感染组和非感染组,比较两组间临床特征差异。二元logistic回归分析HP患者发生感染的危险因素。结果64例HP患者临床表现前三位为性欲减退,乏力、畏寒、纳差;低血钠。64例HP患者病因分析:席汉综合征23例,脑部肿瘤术后(垂体瘤、颅咽管瘤、脑膜瘤)14例,特发性8例,垂体瘤7例,垂体体积、形态改变8例,空泡蝶鞍4例。40.32%(25/62)肾上腺轴功能低下者接受糖皮质激素替代治疗,其中80%(20/25)应用泼尼松、20%(5/25)应用氢化可的松,替代剂量为2.5~25(6.77±3.90)mg泼尼松等效剂量。37.70%(23/61)甲状腺轴功能低下者接受甲状腺激素替代治疗,其中52.17%(12/23)FT_(4)水平仍较正常下限低。性腺轴功能低下患者,≤60岁男性中20%(2/10)、≤50岁女性中5.56%(1/18)接受了性激素替代治疗。纳入的64例HP患者,合并感染(感染组)29例,未合并感染(非感染组)35例。感染组与非感染组在性别、病因、腺垂体受累轴数、糖皮质激素替代治疗剂量、甲状腺激素替代治疗剂量、性激素替代治疗率方面差异无统计学意义(均P>0.05)。与非感染组比较,感染组年龄更大,病程更长,DBP、白蛋白更低,差异均有统计学意义(均P<0.05),其余指标差异均无统计学意义(均P>0.05)。二元logistic回归分析结果显示:年龄、病程、职业、白蛋白水平是HP并发感染的影响因素(均P<0.05)。结论成人腺垂体功能减退的最常见原因是席汉综合征;年龄大、病程长、职业为农民、低白蛋白血症的成人HP患者更易并发感染。

Objective To explore the clinical characteristics and risk factors of concurrent infection in adult patients with hypopituitarism(HP).Methods Clinical data of patients diagnosed with HP in Fuyang People′s Hospital from October 2016 to August 2020 were collected.Patients were divided into infected group and non-infected group according to whether they were co-infected,and the differences in clinical characteristics between the two groups were compared.The risk factors of infection in HP patients were analyzed by binary logistic regression.Results The top three clinical manifestations of 64 HP patients were decreased libido;lack of energy,fear of cold,and poor appetite;hyponatremia.Etiological analysis of 64 HP patients:23 cases of Sheehan′s syndrome,14 cases of postoperative brain tumors(pituitary adenoma,craniopharyngioma,meningioma),8 cases of idiopathic,7 cases of pituitary adenoma,8 cases of pituitary volume and morphology changes,and 4 cases of empty sella turcica.40.32%(25/62)of patients with adrenal axis dysfunction received glucocorticoid replacement therapy,with 80%(20/25)receiving prednisone and 20%(5/25)receiving hydrocortisone.The replacement dose was 2.5-25(6.77±3.90)mg of prednisone equivalent dose.37.70%(23/61)of patients with low thyroid axis function received thyroid hormone replacement therapy,of which 52.17%(12/23)free thyroxine(FT_(4))levels were still lower than the lower normal limit.20%(2/10)of males≤60 years old and 5.56%(1/18)of females≤50 years old received hormone replacement therapy for patients with hypogonadism of the gonadal axis.Among 64 HP patients included,29 were co-infected(infected group)and 35 were not co-infected(non infected group).There was no significant difference between the infected group and the non infected group in gender,etiology,number of pituitary axis involved,glucocorticoid replacement therapy dose,thyroid hormone replacement therapy dose,and sex hormone replacement therapy rate(all P>0.05).Compared with the non infected group,the infected group was older,had a longer course of disease,lower diastolic blood pressure(DBP)and albumin levels,with statistically significant difference(all P<0.05),while the other indicators showed no statistically significant difference(all P>0.05).The results of binary logistic regression analysis showed that age,course of disease,occupation,and albumin level were the influencing factors of HP complicated infection(all P<0.05).Conclusions The most common cause of pituitary dysfunction in adults is Sheehan′s syndrome;Adult HP patients who are older,have a longer course of disease,work as farmers,and have hypoalbuminemia are more likely to develop concurrent infections.