单中心儿童颅咽管瘤手术后下丘脑性肥胖危险因素分析

Risk factors associated with hypothalamic obesity after childhood-onset craniopharyngioma resection in a single center

目的筛查儿童颅咽管瘤患者肿瘤切除术后发生下丘脑性肥胖的危险因素。方法选择2015年6月至2022年9月在首都医科大学附属北京儿童医院接受开颅手术的34例首发颅咽管瘤患儿作为观察对象,回顾分析术前症状与体征、影像学表现、手术过程和随访资料,采用单因素和多因素Logistic回归分析筛查颅咽管瘤切除术后发生下丘脑性肥胖的危险因素。结果术后出现肥胖且伴食欲增加、嗜睡、情绪异常等下丘脑症状的患儿共47.06%(16/34),Logistic回归分析提示术前存在症状性内分泌异常(OR=31.453,95%CI:1.009~980.082;P=0.049)、下丘脑受累程度为Puget分级Ⅱ级(OR=48.844,95%CI:1.053~2264.975;P=0.047)是颅咽管瘤切除术后发生下丘脑性肥胖的危险因素。结论术前存在症状性内分泌异常、Puget分级Ⅱ级是颅咽管瘤患儿术后发生下丘脑性肥胖的危险因素,早期识别危险因素、尽早采取合理有效的干预措施,可改善患儿远期生活质量。

Objective To identify risk factors associated craniopharyngioma resection in children.Methods The clinical data as well as imaging and operation details of 34 children with craniopharyngioma who met the inclusion criteria from June 2015 to September 2022 in Beijing Children's Hospital,Capital Medical University were collected for retrospective analysis.The body mass index(BMI)at last follow-up were recorded to identify hypothalamic obesity,univariate and multivariate Logistic regression analyses were used to screen the risk factors.Results A total of 47.06%(16/34)of children experiened hypothalamic symptoms,including obesity and increased appetite,lethargy and mood abnormalities after surgery.Logistic regression analysis showed that symptomatic endocrine abnormalities(OR=31.453,95%CI:1.009-980.082;P=0.049)and impairment of the hypothalamus of PugetⅡgrade(OR=48.844,95%CI:1.053-2264.975;P=0.047)were risk factors for postoperative hypothalamic obesity.Conclusions There is a high incidence of hypothalamic obesity after childhood-onset craniopharyngioma resection,symptomatic endocrine abnormalities and impairment of the hypothalamus of PugetⅡgrade are risk factors.Early identification of risk factors and early adoption of reasonable and effective interventon measures can improve the long-term quality of life in children.