垂体瘤患者血清E、NE、R、ATⅡ水平变化及临床意义

Changes and clinical significance of serum E,NE,R and ATⅡ in patients with pituitary tumors

目的:分析垂体瘤患者血清肾上腺素(E)、去甲肾上腺素(NE)、肾素(R)及血管紧张素Ⅱ(ATⅡ)水平变化及临床意义。方法:以56例垂体瘤患者(垂体瘤组)、57例非垂体瘤鞍区病变患者(非垂体瘤组)和60名健康体检者(正常组)为研究对象。其中垂体瘤组患者采用神经内镜辅助下经鼻蝶窦入路术加以治疗,同时根据垂体瘤分类法将垂体瘤患者分为功能性组和无功能性组,侵袭性组和无侵袭性组。检测各组血清E、NE、R及ATⅡ水平,采用受试者工作特征曲线(ROC)评价血清E、NE、R及ATⅡ对垂体瘤的诊断价值。结果:垂体瘤组血清E、NE、R及ATⅡ水平高于非垂体瘤组和正常组(P<0.05),非垂体瘤组高于正常组(P<0.05);功能性组血清E、NE、R及ATⅡ水平高于无功能性组(P<0.05);侵袭性组血清E、NE、R及ATⅡ水平高于无侵袭性组(P<0.05);与术前比较,垂体瘤患者术后血清E、NE、R及ATⅡ水平降低,差异有统计学意义(P<0.05);ROC曲线诊断结果显示,E、NE、R和ATⅡ诊断垂体瘤的曲线下面积(AUC)分别为0.907、0.917、0.826和0.849,敏感度分别为85.70%、83.90%、80.40%和64.30%,特异度分别为90.60%、93.20%、75.20%和93.20%,四者联合诊断垂体瘤的AUC为0.954,敏感度为82.10%,特异度为94.90%。结论:血清E、NE、R及ATⅡ对垂体瘤的诊断和鉴别具有一定的临床意义,其表达水平升高,提示垂体瘤可能具有激素分泌功能或侵袭性。

Objective:To analyze the changes and clinical significance of levels of serum epinephrine(E),norepinephrine(NE),renin(R)and angiotensinⅡ(ATⅡ)in patients with pituitary tumors.Methods:56 patients with pituitary tumors(pituitary tumor group),57 patients with non-pituitary tumor sellar region lesions(non-pituitary tumor group)and 60 healthy people with physical examination(normal group)were selected as the research subjects.Patients in pituitary tumor group were treated with neuroendoscopy-assisted transnasal sphenoid sinus approach surgery.According to the classification of pituitary tumors,patients with pituitary tumors were divided into functional group and non-functional group,and invasive group and non-invasive group.The levels of serum E,NE,R and ATⅡ were detected in each group.Receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of serum E,NE,R and ATⅡ on pituitary tumors.Results:The levels of serum E,NE,R and ATⅡ in pituitary tumor group were higher than those in non-pituitary tumor group and normal group(P<0.05),and the levels in non-pituitary tumor group were higher than those in normal group(P<0.05).The levels of serum E,NE,R and ATⅡ in functional group were higher than those in non-functional group(P<0.05),and the levels of serum E,NE,R and ATⅡ in invasive group were higher than those in non-invasive group(P<0.05).Compared with before surgery,the levels of serum E,NE,R and ATⅡ of patients with pituitary tumors were decreased after surgery(P<0.05).ROC curve diagnosis showed that the AUCs of E,NE,R and ATⅡ in diagnosing pituitary tumors were 0.907,0.917,0.826 and 0.849,and the sensitivities were 85.70%,83.90%,80.40% and 64.30%,and the specificities were 90.60%,93.20%,75.20% and 93.20%respectively.The AUC,sensitivity and specificity of four combined diagnosis of pituitary tumors were 0.954,82.10% and 94.90%.Conclusion:Serum E,NE,R and ATⅡ have certain clinical significance in the diagnosis and differentiation of pituitary tumors,and their high levels suggest that pituitary tumors may have hormone secretion function or invasion.