垂体腺瘤患者术前HPA及HPT轴功能低下危险因素及术后疗效分析

An analysis of risk factors for preoperative hypofunction of the HPA and HPT axes in patients with pituitary adenoma and their postoperative outcomes

目的:下丘脑垂体肾上腺轴(hypothalamic-pituitary-adrenal,HPA)和下丘脑垂体甲状腺轴(hypothalamic-pituitary-thyroid,HPT)是人体最重要的生命激素轴,本文旨在研究垂体腺瘤患者术前发生HPA功能低下和HPT功能低下的危险因素,以及该部分患者术后相应激素轴恢复情况。方法:回顾性分析2018年1月至2022年12月于陆军军医大学新桥医院神经外科同一治疗组接受治疗的垂体腺瘤患者,根据纳入排除标准,共纳入504例。对比分析HPA功能及HPT功能正常患者(功能正常组)和至少一个轴功能低下患者的差异性临床因素,采用多因素logistic回归分析术前垂体功能低下的危险因素,随访术前功能低下组并给予手术治疗的患者术后1年内垂体功能恢复情况。结果:功能正常组患者434例,功能低下组70例。功能低下组患者年龄较功能正常组偏大(P=0.049),男性患者占比更高(P=0.001)。并发症方面,功能低下组高血压病占比更低(P=0.037),而高脂血症占比却更高(P=0.033)。肿瘤特征对比发现,功能低下组肿瘤体积较功能正常组明显增大(P<0.001);肿瘤向鞍内生长比例较功能正常组更小(P=0.012);内分泌分型对比发现,功能低下组中无功能型腺瘤占比较正常组明显增高(P<0.001);其余临床变量两组间无明显差异。多因素logistic回归分析显示男性、临床无功能腺瘤、肿瘤体积较大是垂体腺瘤患者HPA及HPT轴低下的独立危险因素(P<0.05)。ROC曲线分析显示肿瘤体积为6.350 cm3最能预测HPA及HPT轴低下(AUC=0.7)。功能低下组手术治疗68例,其中HPA功能低下者41例、HPT功能低下者53例、两个轴功能均低下者26例,术后1年内HPA轴功能恢复率为36.6%、HPT轴功能恢复率为39.6%,两个轴均低下患者1年内均恢复比例为38.5%。结论:男性、肿瘤体积较大、无功能垂体腺瘤是垂体腺瘤患者并发HPA、HPT轴功能低下的高危因素;手术有助于术前HPA及HPT轴功能低下患者不同程度恢复。

Objective:The hypothalamic-pituitary-adrenal(HPA)and hypothalamic-pituitary-thyroid(HPT)axes are the most vital hormonal axes in the human body.This study aims to investigate the risk factors for the preoperative hypofunction of these axes in pa⁃tients with pituitary adenoma and the postoperative recovery of corresponding hormonal axes.Methods:A retrospective analysis was conducted on patients with pituitary adenoma who underwent treatment in the same treatment group at the Department of Neurosurgery,Xinqiao Hospital,Army Medical University,from January 2018 to December 2022.A total of 504 patients were included based on the inclusion and exclusion criteria.The differential clinical factors were compared and analyzed between patients with normal HPA or HPT function(normal function group)and those with hypofunction in at least one of the axes.Multivariate logistic regression was used to analyze the risk factors for preoperative hypopituitarism.The recovery of pituitary function within one year of surgery was followed up in patients who had preoperative hypofunction and underwent surgi⁃cal treatment.Results:The normal function group consisted of 434 patients,while the hypofunction group had 70 patients.The hypo⁃function group had a higher proportion of elderly patients than the normal function group(P=0.049),with a higher proportion of male patients(P=0.001).An analysis of complications found that the hypofunction group had a lower proportion of patients with hypertension(P=0.037),but had a higher proportion of patients with hyperlipidemia(P=0.033).A comparison of tumor characteristics revealed a significant increase in tumor volume in the hypofunction group compared with the normal function group(P<0.001).Additionally,a smaller proportion of intrasellar tumors developed in the hypofunction group than in the normal function group(P=0.012).A compari⁃son of endocrine classification showed a significantly higher proportion of nonfunctional adenomas in the hypofunction group than in the normal function group(P<0.001).There were no significant differences in the remaining clinical variables between the two groups.Multivariate logistic regression analysis revealed that being a male,clinically nonfunctional adenoma,and large tumor volume were in⁃dependent risk factors for hypofunction of the HPA and HPT axes in patients with pituitary adenoma(P<0.05).The receiver operating characteristic curve demonstrated that a tumor volume of 6.350 cm3 was an optimal predictor of hypofunction of the HPA and HPT axes(area under the curve[AUC]=0.7).Sixty-eight patients in the hypofunction group underwent surgical treatment,with 41 cases of hypo⁃functional HPA axis,53 cases of hypofunctional HPT axis,and 26 cases of hypofunction of both axes.The recovery rates for patients with the hypofunction of the HPA axis,HPT axis,and both axes within one year after surgery were 36.6%,39.6%,and 38.5%,respec⁃tively.Conclusion:Being a male,large tumor volume,and nonfunctional pituitary adenomas are high risks for HPA and HPT axis hy⁃pofunction in patients with pituitary adenoma.Surgery can,to varying degrees,help with the recovery in patients with preoperative hy⁃pofunction of the HPA and HPT axes.