PRL水平及垂体MRI对女性泌乳素型垂体腺瘤的鉴别诊断

The Value of PRL Levels and Pituitary MRI in the Differential Diagnosis of Prolactinomas in Women

目的:探讨PRL水平及垂体MRI表现在女性泌乳素型与非泌乳素型垂体腺瘤的鉴别诊断价值。方法:回顾性收集35例行垂体MRI增强检查并术后经病理确诊为垂体大腺瘤的女性高泌乳素血症患者,将其分为泌乳素型腺瘤组(免疫组化结果为PRL[+]或多激素腺瘤包括PRL[+])及非泌乳素型腺瘤组(免疫组化结果为PRL[-]),用多田公式计算腺瘤体积,用Knosp5级分类法判定腺瘤对海绵窦的侵袭性,探讨PRL水平、垂体MRI表现对泌乳素型腺瘤与非泌乳素型腺瘤的鉴别诊断价值。结果:泌乳素型腺瘤组与非泌乳素型腺瘤组患者PRL水平、瘤体体积差异有统计学意义(P<0.05);泌乳素型腺瘤组与非泌乳素型腺瘤组knosp分级差异无统计学意义(P>0.05);PRL/V对泌乳素型腺瘤与非泌乳素型腺瘤的鉴别诊断准确性高于瘤体体积、PRL水平。结论:泌乳素型腺瘤与非泌乳素型腺瘤均可导致高泌乳素血症,PRL/V=12.47ng/ml/cm^(3)可作为二者的鉴别诊断参考(AUC=0.750);结合PRL水平与垂体MRI表现可提高二者的鉴别诊断价值,对合理选择治疗方案、判断预后有重要意义。

Objective:To explore the value of PRL levels and pituitary MRI in the differential diagnosis of prolactinomas and non-Prolactinomas in women.Methods:35 female patients with hyperprolactinemia who had been diagnosed as pituitary macroadenoma after pituitary MRI enhancement examination and postoperative pathological diagnosis were retrospectively collected.They were divided into two groups:prolactinoma group(immunohistochemistry result was PRL[+])or multi hormone adenoma including PRL[+]and non-prolactinnoma group(immunohistochemistry result was PRL[-]).The macroadenoma volume was calculated by the Coniglobus formula and the invasion of adenoma was determined by knosp5 classification.The value of PRL levels and pituitary MRI in the differential diagnosis of prolactinomas and non-Prolactinomas was analyzed.Results:The PRL levels and macroadenoma volume were significantly different between Prolactinoma group and non-Prolactinoma group(P<0.05);the knosp classification of Prolactinoma group and non-Prolactinoma group showed no significant difference(P>0.05);the accuracy of PRL/V in differential diagnosis of Prolactinomas and non-Prolactinomas was higher than that of tumor volume and PRL levels.Conclusion:Both prolactinomas and non-Prolactinomas can cause hyperprolactinemia,PRL/V=12.47ng/ml/cm^(3) can be used as a reference for the differential diagnosis of prolactinomas and non-Prolactinomas(AUC=0.750).The combination of PRL levels and pituitary MRI can improve the value of differential diagnosis,which is of great significance for the reasonable choice of treatment plan and the judgment of prognosis.