中枢神经系统血管母细胞瘤的年龄分层分析  

Age-stratified analysis of clinical features and prognoses of patients with central nervous system hemangioblastomas

作　　者：赵国杰 吴明洪 连海伟[1] 刘仁忠[1] ZHAO Guo-jie;WU Ming-hong;LIAN Hai-wei;LIU Ren-zhong(Department of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院神经外科,武汉430060

出　　处：《中国临床神经外科杂志》2023年第4期230-233,239,共5页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨不同年龄段的中枢神经系统(CNS)血管母细胞瘤(HB)的临床特征、预后及其影响因素。方法回顾性分析2016年1月至2022年1月手术治疗的86例CNS-HB的临床资料。根据初次手术年龄分为四个年龄段(≤20岁、21~40岁、41~60岁和≥61岁),分析不同年龄段临床特征、预后差异。结果CNS-HB以颅内压增高症状为主,其次是小脑症状。肿瘤主要位于幕下,其中小脑占65.6%、脑干占17.7%,其次是脊髓(11.5%),幕上极少(5.2%);实性肿瘤43例(44.8%),囊性肿瘤53例(55.2%)。年龄≤20岁组病程[(1.68±1.87)个月]较年龄≥61岁组[(26.50±50.66)个月]明显缩短(P<0.05)。年龄≤40岁病人VHL病发生率较年龄>40岁病人明显增高(P<0.05)。不同年龄段病人的肿瘤部位、肿瘤性质均无明显差异(P>0.05)。术后41例(42.7%)出现坠积性肺炎,年龄越大,发生肺炎的几率越高(P<0.001)。术后15例(15.6%)出现颅内并发症,实性肿瘤及脑干肿瘤病人术后颅内并发症发生率明显高于囊性肿瘤或肿瘤位于其他部位病人(P<0.05)。末次随访,预后良好78例(81.3%),预后不良8例(18.7%)。多因素logistic回归分析显示男性、肿瘤位于脑干以及实性肿瘤是CNS-HB预后不良的独立危险因素(P<0.001)。结论年轻HB病人的病程较短,而老年HB病人术后并发症发生率较高,但是年龄不是HB病人预后不良的危险因素,肿瘤部位及肿瘤性质与HB病人不良预后有关。40岁以下病人VHL病发病率较高,建议年轻病人积极进行VHL病的筛查。Objective To investigate clinical features and risk factors of prognoses of patients with central nervous system(CNS)hemangioblastoma(HB)in different age groups.Methods The clinical data of 86 patients with CNS-HB who underwent surgery from January 2016 to January 2022 were retrospectively analyzed.According to the patients'age at initial operation,all patients were divided into four groups,i.e.,≤20 years,21~40 years,41~60 years and≥61 years groups.The clinical characteristics and prognoses of pateints in different groups were analyzed.Results The main clinical manifestations were intracranial hypertension symptoms.The tumors were mainly located in the infratentorial area,including cerebellum(65.6%)and brain stem(17.7%).There were 43 patients(44.8%)of solid tumors and 53 patients(55.2%)of cystic tumors.The course of disease in≤20 years group[(1.68±1.87)months]was significantly shorter than that[(26.50±50.66)months]in≥61 years group(P<0.05).The incidence of VHL disease in patients≤40 years was significantly higher than that in patients>40 years(P<0.05).There were no significant differences in tumor site and tumor nature among different groups(P>0.05).After surgery,pendulous pneumonia occurred in 41 patients(42.7%),and the older the patient,the higher the risk of pneumonia(P<0.001).Intracranial complications occurred in 15 patients(15.6%)after surgery,and the incidence of intracranial complications was significantly higher in patients with solid tumors than that in patients with cystic tumors(P<0.05),and the incidence of intracranial complications was significantly higher in patients with brain stem tumors than that in patients with tumors locating at the other sites.At the last follow-up,78 patients(81.3%)had good prognoses,and 8 patients(18.7%)had poor prognoses.Multivariate logistic regression analysis showed that male,tumor locating in the brain stem,and solid tumor were independent risk factors for poor prognoses of patients with CNS-HB(P<0.001).Conclusions Young patients with HB have a shorter cou

关 键 词：中枢神经系统血管母细胞瘤 临床特征 预后 年龄 分层分析 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]