儿童原发颅内生殖细胞肿瘤延迟诊断的危险因素分析  

Analysis of risk factors for delayed diagnosis of primary intracranial germ cell tumors in children

作　　者：万露露 孙黎明[1] 武万水[1] 杜淑旭[1] 孙艳玲[1] 李苗[1] 任思其[1] WAN Lulu;SUN Liming;WU Wanshui;DU Shuxu;SUN Yanling;LI Miao;REN Siqi(Department of Pediatrics,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院,北京100038

出　　处：《中国循证儿科杂志》2023年第5期382-387,共6页Chinese Journal of Evidence Based Pediatrics

摘　　要：背景目前对儿童颅内生殖细胞肿瘤(ICGCTs)的及时诊断仍面临困难。目的 分析ICGCTs患儿延迟诊断的影响因素。设计病例对照研究。方法 纳入2011年10月至2021年4月在首都医科大学附属北京世纪坛医院就诊的ICGCTs患儿,发病至诊断时间≥6个月为延迟诊断组,反之为无延迟诊断组。根据导致延迟诊断的原因将延迟诊断组进一步分为疾病原因亚组、家庭原因亚组和诊断原因亚组。截取患儿的一般信息、临床表现、辅助检查等临床资料,在两组间单因素有序Logistic回归分析的基础上行多元Logistic回归分析。主要结局指标ICGCTs延迟诊断的影响因素。结果 158例ICGCTs患儿纳入分析,男114例,女44例。无延迟诊断组88例,延迟诊断组70例,其中疾病原因亚组15例,家庭原因亚组23例,诊断原因亚组32例。起病症状:无延迟诊断组以高颅压三主征多见,疾病原因亚组和家庭原因亚组以内分泌症状多见,诊断原因亚组以神经精神症状和内分泌症状多见。诊断原因亚组以肿瘤多病灶为主,其余各组以单病灶为主。无延迟诊断组病理分型为非生殖细胞性的生殖细胞瘤(NGGCTs)、肿瘤最大直径≥3 cm、发生脑积水、需行脑室腹腔分流术/三脑室底造瘘术的患儿较多,β-HCG≥5 mIU·mL^(-1)在发病≥6个月出现的患儿较少。进一步分析导致延迟诊断的危险因素后发现,内分泌症状是家庭原因亚组患儿延迟诊断的危险因素;诊断原因亚组中高颅压三主征、肿瘤最大直径≥3 cm是患儿延迟诊断的保护因素,β-HCG≥5 mIU·mL^(-1)在发病≥6个月出现是延迟诊断的危险因素。结论 ICGCTs的延迟诊断与疾病自身特征、患儿家庭认知和医院诊疗水平相关,需根据患儿具体情况制定个体化诊疗方案。Background Timely diagnosis of primary intracranial germ cell tumors(ICGCTs)still posed a big challenge.Objective To analyze the risk factors for delayed diagnosis of ICGCTs in children.Design Case-control study.Methods Children with ICGCTs were enrolled from Department of Pediatrics at Beijing Shijitan Hospital,Capital Medical University between October 2011 to April 2021.ICGCT children with the time from onset to diagnosis≥6 months were taken as the delayed diagnosis group,and those with less than 6 months were put into the non-delayed diagnosis group.According to the reasons that cause delayed diagnosis,the delayed diagnosis group was further divided into disease group,family group,and diagnosis group.The demographic features,clinical manifestations and ancillary examinations were collected.Risk factors were established by univariate analysis and multivariate logistic regression analysis.Main outcome measures Risk factors for delayed diagnosis of ICGCTs.Results There were 114 males and 44 females in 158 children with ICGCTs.There were 88 cases in the non-delayed diagnosis group and 70 cases in the delayed diagnosis group including 15 cases in the disease group,23 cases in the family group,and 32 cases in the diagnosis group.The most common primary symptoms were high intracranial pressure symptoms in the non-delayed diagnosis group,endocrine symptoms in the disease group and family group,and neuropsychiatric and endocrine symptoms in the diagnosis group.Multiple tumor lesions were mainly seen in the diagnostic group.In the non-delayed diagnosis group,there were more children with pathological type of NGGCTs,maximum diameter of tumor≥3 cm,hydrocephalus,and need for ventriculoperitoneal shunt/third ventriculostomy.There are fewer children withβ-HCG≥5 mIU·mL^(-1) after at least 6 months of onset.Further analysis of the risk factors leading to delayed diagnosis found that endocrine symptoms were risk factors for delayed diagnosis in the family subgroup;the three main signs of high intracranial pressure and

关 键 词：颅内生殖细胞肿瘤 延迟诊断 危险因素 预后 儿童 

分 类 号：R739.41[医药卫生—肿瘤]