生长激素(GH)水平在垂体GH腺瘤缓解及预后判断中的意义  

Significance of the growth hormone in assessment of surgical remission and prognosis in pituitary GH-secreting adenomas

作　　者：陈晓[1] 何新尧[1] 施秀华[1] 孙青芳[1] 卞留贯[1] 赵卫国[1] 沈健康[1] 李小英[2] 宁光光 

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

出　　处：《中华神经外科疾病研究杂志》2013年第3期235-238,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：上海市自然科学基金资助项目(08ZR1413800)

摘　　要：目的探讨生长激素(GH)水平的测定在垂体GH腺瘤手术缓解及预后判断中的意义。方法回顾性分析91例经鼻蝶垂体腺瘤切除术的GH腺瘤的病例。分别测定术前、术后1 d及1 w空腹垂体激素水平。结果手术缓解率为67.0%,微腺瘤与大腺瘤缓解率(P<0.001)、侵袭性与非侵袭性腺瘤缓解率(P<0.001)、术前各浓度的术后缓解率(P<0.05)、术中GH下降大于50%组与GH下降不足30%组缓解率(P<0.01)均有明显差异。鞍内局限组与鞍外扩展组缓解率无明显差异(P>0.05)。术后1 d、1 w、1个月激素缓解率无明显差异(P>0.05)。结论术前、术后早期(术后1w、1个月)GH水平和术中GH下降程度对预后有重要预测价值;手术疗效与肿瘤大小、是否侵袭性生长和术前激素水平显著相关。Objective To evaluate the significance of growth hormone （GH） measurement in assessment of surgical remission and prognosis after surgery for the growth of hormone-secreting pituitary adenomas. Methods The outcomes of transsphenoidal surgery in 91 patients with GH-secreting pituitary adenoma were analyzed retrospectively. The level of each pituitary axis hormone in fasting blood samples was measured pre-operation, 1 d and I w post- operation. Results Total remission rate was 67.0%. The significant difference in remission rate was found between microadenomas and macroadenomas （ P 〈 0. 001 ）, invasive adenomas and non-invasive adenomas （ P 〈0. 1301 ）, intra-operative GH level reduction 〉 50% group and 〈 30% group （P 〈 0. 01 ）, and among several groups with different pre-operative GH level （P 〈0.05, respectively）. No obvious difference was observed in remission between intrasellar and extrasellar groups （P 〉0.05） and among 1 d after post-operation, 1 w after post-operation and 1 month after post-operation （P 〉0. 05）. Conclusion The therapeutic outcome is associated with the size, invasiveness of the tuners and the pre-operative level of GH. Pre-operative and early post-operative GH levels （within 1 w and 1 month after surgery）, and the decrease of intra-operative GH may predict the clinical outcome of GH-secreting pituitary adenoma.

关 键 词：肢端肥大症 垂体肿瘤 生长激素 预后 术中监测 

分 类 号：R736.4[医药卫生—肿瘤]