血浆和肽素水平在垂体腺瘤患者术后尿崩症评估中的价值  

The assessment value of plasma copeptin level in postoperative diabetes insipidus of pituitary adenoma patients

作　　者：林昆哲 魏梁锋[1] 黄银兴[1] 赵琳[1] 洪景芳[1] 王守森[1] Lin Kunzhe Wei Liangfeng Huang Yinxing Zhao Lin Hong Jingfang Wang Shousen.(Department of Neurosurgery, Fuzhou General Hospital, Fuzhou 350025, Chin)

机构地区：[1]福州总医院神经外科,350025

出　　处：《中华神经外科杂志》2017年第4期388-391,共4页Chinese Journal of Neurosurgery

基　　金：福建省自然科学基金（201513014）;南京军区福州总医院创新团队（2014CXTD07）;南京军区福州总医院青年育才项目（2014Q32）

摘　　要：目的探讨垂体腺瘤患者的血浆和肽素水平对术后尿崩症的评估价值。方法前瞻性连续性收集2014年3月至2015年3月福州总医院神经外科收治的53例垂体腺瘤患者的临床资料。所有病例均行经鼻蝶窦入路手术切除肿瘤。术前行MRI检查观测垂体后叶亮点（PPBS）的显示情况和信号比。采用ELISA检测术前、术后第1天的血浆和肽素水平，且于术后监测尿量。根据术后有无尿崩症将患者分为尿崩症组（23例）和对照组（未发生尿崩症，30例）。根据PPBS结果将患者分为PPBS阳性组（45例）和PPBS阴性组（8例）。分析垂体腺瘤患者的血浆和肽素水平与术后尿崩症以及PPBS的关系。结果无论是尿崩症组或对照组，其术前、术后的血浆和肽素水平[M（P25，P75）]的差异均元统计学意义（均P〉0．05）。尿崩症组的术前、术后第1天的血浆和肽素水平[分别为5．35（4．24，8．25）pmol／L）和4．87（4．08，6．43）pmol／L]均低于对照组[术前：6．82（4．99，10．77）pmol／L，术后：6．21（4．81，9．84）pmol／L]（均P〈0．05）。PPBS阳性组的术前血浆和肽素水平[6．57（4．87，10．39）pmol／L]高于PPBS阴性组[4．65（3．49，6．23）pmol／L]（P〈0．05）。PPBS的信号强度与血浆和肽素水平无相关性（P〉0．05）。结论血浆和肽素水平可作为垂体腺瘤术后尿崩症的预测指标。术前、术后第1天血浆和肽素水平较低的垂体腺瘤患者其术后发生尿崩症的风险较高。Objective To explore the assessment value of plasma copeptin level in postoperative diabetes insipidus of pituitary adenoma patients. Methods A total of 53 patients with pituitary adenoma were admitted to Department of Neurosurgery, Fuzhou General Hospital from March 2014 to March 2015 and their data were consecutively collected and prospectively analyzed in this study. All cases underwent tumor resection using transsphenoidal approach. MRI examination was performed preoperatively to observe posterior pituitary bright spot （PPBS）. The plasma copeptin level was detected with the method of ELISA preoperatively and 1 day post surgery. The volumes of urine were documented postoperatively. Patients were divided into diabetes insipidus group （ n = 23） and control group （ without diabetes insipidus, n = 30）. In addition, patients were also separated into PPBS positive group （ n = 45 ） and PPBS negative group （ n = 8 ）. The relationship between copeptin, PPBS and postoperative diabetes insipidus was analyzed. Results In the diabetes insipidus group, the average concentration of copeptin was 5.35 （4.24,8.25）pmol/L preoperatively, which was not significant different from that assessed 1 day post surgery 4.87 （4.08,6.43） pmol/L （ P 〉 0.05）. In the control group, the preoperative and postoperative （1 day post surgery） concentrations of copeptin were 6.82 （4.99,10.77） pmol/L and 6.21 （4.81,9.84） pmol/L, respectively, and the difference was not significant （ P 〉 0.05）. The average concentrations of copeptin in the diabetes insipidus group were significantly lower than those in the control group （P 〈 0.05） both preoperatively and postoperatively. The average concentration of eopeptin 6.57 （4.87,10.39）pmol/L in PPBS-positive group was higher than that in PPBS-negative group 4.65 （3.49,6.23）pmol/L （P 〈 0.05 ）. There was no correlation between the intensity of PPBS and plasma copeptin level （ P 〉 0. 05 ）. Conclusions Copeptin could serve as a predictive

关 键 词：垂体肿瘤 尿崩症 和肽素 垂体后叶亮点 

分 类 号：R736.4[医药卫生—肿瘤]