儿童颅咽管瘤神经内分泌功能受损及功能分级评价临床研究  

Clinical research on neuroendocrine dysfunction and grading of neuroendocrine function in children with craniopharyngioma

作　　者：郭莹[1] 钟历勇[1] 姜中利[2] 倪明[2] 刘伟明[2] 

机构地区：[1]首都医科大学附属北京天坛医院内分泌科,100050 [2]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中国医师进修杂志》2015年第9期674-679,共6页Chinese Journal of Postgraduates of Medicine

基　　金：首都临床特色应用研究资助项目（Z121107001012020）

摘　　要：目的探讨颅咽管瘤患儿鞍区肿瘤原位占位效应（OETS）与神经外科手术后（ANS）两种状态对神经内分泌功能受损及功能分级的影响。方法根据文献与内分泌长反馈调节轴原理拟定“颅咽管瘤神经内分泌功能受损（儿童）分级评价标准”，以该分级评价标准为工具回顾性地比较行颅咽管瘤手术治疗的227例颅咽管瘤患儿的临床资料，将上述患儿分为青春期前组（167例）、青春期组（60例），分别评价OETS与ANS两种状态对颅咽管瘤患儿神经内分泌功能的影响。结果在227例患儿中，垂体．甲状腺轴受损率由OETS状态的16．74％（38／227）升至ANS状态的67．40％（153／227），垂体-肾上腺轴受损率由OETS状态的14．54％（33／227）升至ANS状态的44．49％（101／227），神经垂体功能受损率由OETS状态的17．62％（40／227）升至ANS状态的21．15％（48／227）；此外，下丘脑功能如体温调节异常、睡眠障碍、人格异常与认知受损率OETS状态均较ANS状态增加。青春期前组ANS状态较OETS状态神经内分泌功能受损评分（z=-5．20，P〈0．01）及功能分级（z=-4．94，P〈0．01）均升高。青春期组ANS状态较OETS状态神经内分泌功能受损评分（z=-4．10，P〈0．01）及功能分级（z=-4．25，P〈0．01）均升高。结论OETS和ANS状态对神经内分泌功能均有不同程度的损害，手术治疗尽管可解除鞍区肿瘤原位占位效应，但在短期内可增加颅咽管瘤神经内分泌功能受损的评分与功能分级。颅咽管瘤神经内分泌功能受损（儿童）分级评价标准能够反映患儿在不同时期神经内分泌功能受损的严重程度，有利于医师从错综复杂的内分泌功能指标中总体掌控功能受损特点。Objective To compare the effect of occupy effects of tumor in situ before surgery（OETS） and after neurosurgery （ANS） on neuroendocrine dysfunction and grading of neuroendocrine function in children with craniopharyngioma. Methods The grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma were drew up according to references and the endocrine feedback principle. Based on these grading evaluation criteria, the clinical date of 227 cases of children with craniopharyngioma who underwent neurosurgical treatment were retrospectively studied. These children were divided into pre-pubertal group （167 cases） and pubertal group （60 cases）. The neuroendocrine impairment status before and after the surgery were evaluated separately. Results Among 227 children with craniopharyngioma, after the surgery, the incidence of the hypothalamus-pituitary-thyroid dysfunction increased from 16.74%（38/227） to 67.40%（153/227）, the incidence of the hypothalamus-pituitary-adrenal gland dysfunction increased from 14.54% （33/227） to 44.49% （101/227）, and the the incidence of pituitary function impairment increased from 17.62%（40/227） to 21.15%（48/227）. Meanwhile, the incidence of body temperature dysregulation, sleeping disorder, personality abnormality and cognitive abnormality all increased after the surgery. The scoring and grading on neuroendocrine dysfunction in pre-pubertal group were increased after the surgery （Z =- 5.20, P 〈 0.01; Z =-4.94, P 〈 0.01,）. The scoring and grading on neuroendocrine dysfunction in pubertal group were increased after the surgery（Z = -4.10, P 〈 0.01; Z= -4.25, P 〈 0.01）. Conclusions Both the mass effect of tumor in situ of craniopharyngioma and the neurosurgical treatment can be harmful to the neuroendocrine function. Even though the surgery can remove the mass effect of tumor in situ in the saddle area, it can increase the level of grading of neuroendocrine dysfunction. The status of neuroendocrine dysfunction can b

关 键 词：颅咽管瘤 儿童 神经内分泌 功能评价 

分 类 号：R739.4[医药卫生—肿瘤]