库欣病术后相关缓解因素的研究  

Study of correlative mitigating factors after the surgery for Cushing's disease

作　　者：范长燕[1] 施秀华[1] 孙青芳[1] 卞留贯[1] 赵卫国[1] 沈健康[1] 苏颋为[2] 王卫庆[2] 李小英[2] 宁光[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院神经外科,200025 [2]上海市内分泌代谢病临床医学中心

出　　处：《中国微侵袭神经外科杂志》2011年第5期193-196,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：上海市自然科学基金(编号:08ZR1413800)

摘　　要：目的探讨库欣病经蝶手术后相关缓解因素。方法回顾性分析104例经蝶手术的库欣病的临床资料。根据术后早期缓解情况分为缓解组与未缓解组,统计分析两组间的差异,判断影响库欣病术后缓解的因素。结果缓解组与未缓解的术后血皮质醇水平差异在各时间段均有统计学意义(P<0.05),术后24 h尿皮质醇水平差异在术后1～2 d和术后1个月有统计学意义(P<0.05)。8 mg地塞米松抑制试验第3天血皮质醇抑制率>50%者,在缓解组占85.5%,在未缓解组占62.5%;术前MRI检查阳性者术后缓解率为86.8%,阴性缓解率为61.5%;术后病理酶标染色阳性者缓解率为87.2%,阴性缓解为66.7%,其差异均有统计学意义(P<0.05)。结论术前8 mg地塞米松抑制试验、术前MRI检查、术后血皮质醇水平和病理检查等可作为库欣病经蝶手术后,判断预后的指导。Objective To explore the correlative mitigating factors of Cushing＇s disease after transsphenoidal surgery.Methods Clinical data of 104 patients with Cushing＇s disease treated by transsphenoidal surgery were analyzed retrospectively.The patients were divided into remission group and non-remission group according to the early remission postoperatively,and the differences between both groups were analyzed statistically to judge the factors influencing on remission after the surgery for Cushing＇s disease.Results A significant difference in the plasma cortisol levels at every time point postoperatively was found between remission group and non-remission group（P0.05）,however,the 24 h urinary free cortisol just at the time of 1 to 2 days and 1 month postoperatively showed significant differences（P0.05）.At the third day after 8-mg dexamethasone suppression test,the patients whose plasma cortisol inhibition rate was above 50% accounted for 85.5% in remission group and 62.5% in non-remission group.The remission rate was 86.8% in the patients with positive result for MRI and 61.5% those with negative one.The remission rate was 87.2% in the patients with positive result for pathological examination and 66.7% in those with pathological negative ones.There was statistical significance in the differences above（P0.05）.Conclusions After transsphenoidal surgery of Cushing＇s disease,the prognosis can be judged by 8-mg dexamethasone suppression test,preoperative MRI,postoperative plasma cortisol level and pathological examination.

关 键 词：垂体肿瘤 库欣综合征 预后 神经外科手术 

分 类 号：R736.4[医药卫生—肿瘤]