垂体生长激素腺瘤患者的临床特点及手术疗效初步分析  

Preliminary analysis of the clinical features and surgical efficacy in patients with growth hormone- secreting pituitary adenoma

作　　者：白吉伟[1] 李储忠[2] 桂松柏[1] 赵澎[1] 曹磊[1] 乌优图[2] 李振业[2] 洪礼传[2] 张亚卓[2] 

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]首都医科大学北京市神经外科研究所 北京脑重大疾病研究院

出　　处：《中华神经外科杂志》2015年第7期653-657,共5页Chinese Journal of Neurosurgery

基　　金：北京市自然科学基金（7144198）;卫生部公益项目（201402008）

摘　　要：目的研究生长激素（GH）腺瘤的临床特点及其与手术疗效的关系。方法纳入2011年1月至2013年10月首都医科大学附属北京天坛医院神经外科采用手术治疗的GH腺瘤患者167例。观察患者的临床特征，探讨其与手术疗效的关系；免疫组化染色观察腺瘤的激素表达情况。结果167患者中，男、女比例为1：1．12（79／88）；30～50岁者占63．7％（106例）。微腺瘤22例（13．2％），大腺瘤117例（70．1％），巨大腺瘤28例（16．8％）。侵袭性腺瘤63例（37．7％），非侵袭性腺瘤104例（62．3％）。非侵袭性腺瘤切除程度高于侵袭性腺瘤，差异有统计学意义（P=0．01）。术前血浆GH中位水平27ng/ml；术前催乳素〉正常值（20ng/ml）的有43例（25．8％）。术前GH水平与肿瘤体积呈正相关（r=0．285，P〈0．01）。手术前后GH水平呈正相关（r=0．541，P〈0．01）。免疫组化显示，腺瘤多激素表达阳性者占51．8％（85／164），单GH激素表达阳性者占48．2％（79／164），两组侵袭性及术前GH水平差异无统计学意义。随访0．6～4．3年，158例术前存在肢端肥大症者，150例缓解；术后糖尿病治愈21．4％（9／42），缓解21．4％（9／42）；高血压治愈16．3％（7／43），缓解14．0％（6／43）。结论GH腺瘤常见于中青年，明确诊断时多为大腺瘤。术前GH水平与肿瘤体积相关；手术对部分患者的高血压和糖尿病等合并症有效。侵袭性腺瘤手术切除程度不如非侵袭性腺瘤。Objective To study the relationship between the clinical features of growth hormone （GH）-secreting pituitary adenomas and surgical treatment. Methods A total of 167 patients with GH adenoma underwent surgical treatment at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2011 to October 2013 were enrolled. The clinical features of the patients were observed. Its relationship with surgical efficacy was investigated. Immunohistochemical staining was used to observe the hormone expression of adenoma. Results In the 170 patients, the ratio of male and female was 1 ： 1.12 （79/88）. The patients of 30 to 50 years accounted for 63.7% （n = 106）. Twenty-two patients （13.2%） had microadenoma, 117 （70. 1% ） had macroadenoma, and 28 （ 16.8% ） had giant adenoma. Sixty-three patients （37. 7% ） had invasive adenoma and 104 （62. 3% ） bad non-invasive adenoma. The resection extent of non-invasive adenomas was higher than that of the invasive ones, and there was significant difference （P = 0.01 ）. The median preoperative plasma GH level was 27 ng/ml; there were 43 patients （25.8%） the preoperative prolactin 〉 normal value （20 ng/ml）. The preoperative GH level was positively correlated with tumor volume （r = 0. 285, P 〈 0.01 ）. The preoperative and postoperative GH levels were positively correlated with tumor volume （ r = 0. 541, P 〈 0.01 ）. Immunohistochemistry showed that the plurihormonal positive expression of adenoma accounted for 51.8% （79/164）. Single GH hormone positive expression accounted for 48.2% （79/164）. There was no significant difference in the invasion and the preoperative GH level between the two groups. The patients were followed up for 0.6 to 4.3 years, 150 of 158 patients with acromegaly were relieved; after procedure, 21.4% of patients with diabetes were cured （9/42） and 21.4% （9/42） were relieved; 16.3% （7/43） of hypertension were cured and 14.0% （6/43） were relieved. Conclusions

关 键 词：分泌生长激素的脑垂体腺瘤 疾病特征 肿瘤体积 手术 

分 类 号：R736.4[医药卫生—肿瘤]