垂体腺瘤发生急性出血性卒中的影响因素分析  

Analysis of influencing factors for acute hemorrhagic apoplexy in pituitary adenomas

作　　者：宋浩 乔奕胜 陈孝祥 徐蛟天 王威 李俊君[1] 王腾飞 邓兴力[1] 王伟民[1] Song Hao;Qiao Yisheng;Chen Xiaoxiang;Xu Jiaotian;Wang Wei;Li Junjun;Wang Tengfei;Deng Xingli;Wang Weimin(Department of Neurosurgery,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Neurosurgery,Wenzhou Central Hospital,Wenzhou 325000,China;Department of Neurosurgery,The People′s Hospital of Chuxiong Yi Autonomous Prefecture,Chuxiong 675000,China)

机构地区：[1]昆明医科大学第一附属医院神经外科,650032 [2]温州市中心医院神经外科,325000 [3]楚雄彝族自治州人民医院神经外科,云南675000

出　　处：《中华神经外科杂志》2021年第5期466-470,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨垂体腺瘤发生急性出血性卒中的影响因素。方法回顾性分析2015年1月至2017年12月昆明医科大学第一附属医院神经外科手术治疗的319例垂体腺瘤患者的临床资料。根据是否发生垂体腺瘤急性出血性卒中分为卒中组(60例)和非卒中组(259例)。采用单因素和多因素logistic回归分析法判断年龄、性别、高血压病史、糖尿病史、肿瘤直径、肿瘤类型及复发性肿瘤等因素是否为垂体腺瘤发生急性出血性卒中的影响因素。绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),寻找预测垂体腺瘤卒中的危险因素的最佳临界值。结果单因素分析结果显示,两组间性别、年龄、糖尿病史、肿瘤类型的差异均无统计学意义(均P>0.05);而高血压病史、肿瘤直径以及复发性肿瘤在两组之间的差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,高血压病史(OR=2.270,95%CI:1.090~4.728,P=0.029)、肿瘤直径(OR=1.087,95%CI:1.048~1.126,P<0.001)及复发性肿瘤(OR=3.266,95%CI:1.343~7.944,P=0.009)均为垂体腺瘤发生急性出血性卒中的独立危险因素。肿瘤直径预测垂体腺瘤发生急性出血性卒中的ROC曲线显示,AUC=0.718(95%CI:0.658~0.779,P<0.001),最佳临界值为24.5 mm,灵敏度为85%,特异度为45.6%。肿瘤直径≤25 mm者167例,其中垂体腺瘤卒中者16例,非卒中者151例;肿瘤直径>25 mm者152例,其中垂体腺瘤卒中者44例,非卒中者108例。肿瘤直径>25 mm是垂体腺瘤发生急性出血性卒中的危险因素(OR=3.845,95%CI:2.062~7.170,P<0.001)。结论有高血压病史、肿瘤直径>25 mm以及复发性的垂体腺瘤患者易发生垂体腺瘤急性出血性卒中。Objective To investigate the influencing factors for acute hemorrhagic apoplexy in pituitary adenoma.Methods A retrospective analysis was conducted on the clinical data of 319 patients with pituitary adenomas undergoing surgery at Department of Neurosurgery,the First Affiliated Hospital of Kunming Medical University from January 2015 to December 2017.According to the presence or absence of acute hemorrhagic apoplexy in pituitary adenomas,the patients were divided into apoplexy group(60 cases)and non-apoplexy group(259 cases).Univariate and multivariate logistic regression analyses were used to determine whether age,gender,hypertension,diabetes,tumor diameter,tumor type,recurrent tumor and other factors were the influencing factors of acute hemorrhagic apoplexy in pituitary adenomas.Receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to identify the best cut-off value of risk factors for predicting pituitary adenoma apoplexy.Results The results of univariate analysis showed that there was no significant difference in gender,age,diabetes or tumor type(all P>0.05),while the differences between the two groups in hypertension,tumor diameter classification and recurrent tumor were statistically significant(all P<0.05).Multivariate logistic regression analysis results showed that hypertension(OR=2.270,95%CI:1.090-4.728,P=0.029),tumor diameter(OR=1.087,95%CI:1.048-1.126,P<0.001)and recurrent tumor(OR=3.266,95% CI:1.343-7.944,P=0.009)were independent risk factors for apoplexy of pituitary adenomas.The ROC curve of tumor diameter predicting pituitary adenoma apoplexy showed that AUC value was 0.718(95% CI:0.658-0.779,P<0.001),the best cut-off value was 24.5 mm,the sensitivity was 85%,and the specificity was 45.6%.There were 167 cases with tumor diameter≤25 mm,including 16 cases with acute hemorrhagic apoplexy in pituitary adenoma and 151 cases without apoplexy.There were 152 cases with tumor diameter>25 mm,including 44 cases with pituitary adenoma apoplexy and 108 cases without apoplexy

关 键 词：垂体肿瘤 垂体卒中 脑出血 危险因素 

分 类 号：R736.4[医药卫生—肿瘤]