儿童弥散内生型脑桥胶质瘤的自然病史及预后因素分析  

Pediatric diffuse intrinsic pontine gliomas：natural history and prognostic factors

作　　者：泮长存[1] 汤劼[1] 李德志[1] 阴鲁鑫[2] 武文浩[1] 王宇[1] 历俊华[3] 万虹[3] 张力伟[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050 [2] 徐州医学院附属医院神经外科 [3] 首都医科大学北京市神经外科研究所

出　　处：《中华神经外科杂志》2015年第2期115-118,共4页Chinese Journal of Neurosurgery

基　　金：北京市优秀人才培养计划（2012D003034000025）

摘　　要：目的 探讨未经治疗的弥散内生型脑桥胶质瘤（DIPG）患儿的自然病史及预后因素.方法 对2010年10月至2012年6月就诊于首都医科大学附属北京天坛医院神经外科的20例DIPG患儿进行回顾性分析,纳入分析的预后因素包括：性别、年龄、有无外展神经麻痹、病变有无强化、病变是否包绕基底动脉、病变是否突破脑干表面向外生长、有无脑积水、病史长短以及就诊时的远期生活质量评估量表（KPS）评分.结果 中位生存期为23周,1年生存率为10％,2年生存率为5％.病变强化组的生存期比无强化组长,但差异无统计学意义（P＞0.05）.单因素分析结果表明,性别、病史长短和就诊时的KPS评分与预后相关（P=0.01）,而在多因素分析中,仅病史≤1.5个月及就诊时KPS评分≤70分为预后影响因素（P=0.05）.结论 对于DIPG患儿,病史和就诊时KPS评分是预后相关因素.早期有无外展神经麻痹及病变是否包绕基底动脉和预后无关.年龄、病变是否强化和脑积水的处理与否是否影响预后仍存争议.Objective To retrospectively analyze the natural history and prognostic factors of untreated pediatric diffuse intrinsic pontine gliomas （DIPGs）.Methods Twenty pediatric patients newly diagnosed with DIPGs in Beijing Tiantan Hospital from October 2010 to June 2012 were reviewed.The prognostic factors included gender,age,abducens palsy,enhancement,encasement of the basilar artery,presence of exophytic component,hydrocephalus,diagnostic latency and KPS at diagnosis.Results The median survival was 23 weeks.One-year-survival rate was 10% and two-year-survival rate was 5%.Patients with enhancing lesions had a longer survival than those with nonenhancing lesions,but this difference was not statistically significant.Gender,diagnostic latency and KPS at diagnosis had prognostic value （P =0.01） in univariate analysis.But only diagnostic latency ≤ 1.5 months and KPS ≤ 70 at diagnosis were associated with shorter survival time （P =0.05） during multivariate analysis.Conclusions The study revealed that only diagnostic latency and KPS at diagnosis carried prognostic value.Early presence of aducens palsy and encasement of basilar artery had no prognostic value.Age,enhancement and hydrocephalus might have prognostic value but need further investigation.

关 键 词：脑桥胶质瘤 自然病史 预后 

分 类 号：R739.41[医药卫生—肿瘤]