伽玛刀治疗泌乳素瘤临床效果及其对患者激素水平影响研究

Clinical effect of gamma knife therapy on prolactinoma and its effect on hormone levels in patients

目的 观察伽玛刀治疗泌乳素瘤的临床效果,并探讨其对患者激素水平的影响。方法 选取北部战区总医院2012—2020年收治的145例首次接受伽玛刀立体定向放疗的泌乳素瘤患者为研究对象。根据治疗方式不同,将患者分为伽玛刀组(n=45)和联合组(n=100)。伽玛刀组患者未行手术,采用伽玛刀放疗;联合组患者接受手术及术后伽玛刀放疗。比较两组的治疗效果,比较放疗前8:00(T1)和放疗后1个月8:00(T2)的激素(泌乳素、促肾上腺皮质激素、皮质醇、促甲状腺激素)水平;采用Pearson分析激素之间的相关性,采用Logistic分析影响患者预后的因素。结果 联合组完全缓解率高于伽玛刀组,伽玛刀组部分缓解率高于联合组,差异有统计学意义(P<0.05)。伽玛刀组和联合组T2时的泌乳素水平均低于T1时,差异有统计学意义(P<0.05)。与T1时比较,两组T2时的促肾上腺皮质激素、皮质醇、促甲状腺激素水平回归正常,差异有统计学意义(P<0.05)。泌乳素与促肾上腺皮质激素、皮质醇、促甲状腺激素分别呈极弱负相关(r=-0.253,P=0.001)、负相关(r=-1.600,P=0.026)、不相关(r=0.015,P=0.619);促肾上腺皮质激素与皮质醇、促甲状腺激素分别呈低度正相关(r=0.460,P<0.001)、极弱负相关(r=-0.184,P=0.026);皮质醇与促甲状腺激素呈极弱负相关(r=-0.268,P<0.001)。145例患者中,完全缓解+部分缓解共130例(预后良好组),疾病稳定+疾病进展共15例(预后不佳组)。预后良好组和预后不佳组肿瘤大小、肿瘤位置、泌乳素水平、年龄、体质量指数比较,差异有统计学意义(P<0.05)。肿瘤大小、肿瘤位置、体质量指数、年龄是影响预后的独立危险因素(比值比分别为1.256、1.288、0.933、0.977,P<0.05)。结论 伽玛刀治疗泌乳素瘤的临床效果显著,可调节激素水平,改善患者预后。

Objective To observe the clinical effect of gamma knife treatment of prolactinoma,and to explore the effect of gamma knife treatment on hormone levels in patients.Methods A total of 145 prolactinoma patients who received stereotactic gamma knife radiotherapy for the first time from 2012 to 2020 were selected as subjects.Patients were divided into gamma knife group(n=45)and combined group(n=100)according to different treatment methods.The patients in the gamma knife group received radiotherapy with-out operation.Patients in the combined group received surgery and postoperative gamma knife radiotherapy.The treatment effects were compared between the two groups.Hormone levels(prolactin,corticotropin,cortisol and thyrotropin)were compared between 8:00(T1)before radiotherapy and 8:00(T2)one month after radiotherapy.Pearson was used to analyze the correlation between hormones,and Lo-gistic was used to analyze the factors affecting the prognosis of patients.Results The complete remission rate of the combined group was higher than that of the gamma knife group,and the partial remission rate of the gamma knife group was higher than that of the com-bined group,the difference was statistically significant(P<0.05).The level of prolactin at T2 in gamma knife group and combined group was lower than that at T1,the difference was statistically significant(P<0.05).Compared with T1,the levels of corticotropin,cortisol and thyrotropin in the two groups returned to normal at T2,and the differences were statistically significant(P<0.05).Prolac-tin had very weak negative correlation(r=-0.253,P=0.001),negative correlation(r=-1.600,P=0.026),and no correlation(r=0.015,P=0.619)with corticotropin,cortisol and thyrotropin,respectively.Corticotropin had a low positive correlation(r=0.460,P<0.001)and a very weak negative correlation(r=-0.184,P=0.026)with cortisol and thyrotropin,respectively.There was a very weak negative correlation between cortisol and thyrotropin(r=-0.268,P<0.001).Among the 145 patients,a total of 130 cases had complete response+partial response(good prognosis group),and 15 cases had stable disease+disease progression(poor prognosis group).There were significant differences in tumor size,tumor location,prolactin level,age and body mass index between the good prognosis group and the poor prognosis group(P<0.05).Tumor size,tumor location,body mass index and age were independent risk factors for prognosis(OR=1.256,1.288,0.933,0.977,P<0.05).Conclusion Gamma knife is effective in the treatment of pro-lactinoma,which can regulate hormone levels and improve the prognosis of patients.