无功能垂体神经内分泌肿瘤术后垂体功能减退的影响因素分析  

Analysis of influencing factors of hypopituitarism after surgery for non-functioning pituitary neuroendocrine tumors

作　　者：翟一轩 杨凤东[1] 李建国 张学志 魏新亭[1] 薛亚轲[1] Zhai Yixuan;Yang Fengdong;Li Jianguo;Zhang Xuezhi;Wei Xinting;Xue Yake(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450052

出　　处：《中华神经外科杂志》2024年第6期559-563,共5页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190104)。

摘　　要：目的探讨无功能垂体神经内分泌肿瘤术后垂体功能减退的影响因素.方法回顾性分析中国国家脑肿瘤注册登记平台中郑州大学第一附属医院神经外科于2019年1月至2022年12月登记的无功能垂体神经内分泌肿瘤单病种数据,共纳入患者1210例.收集患者的年龄、性别、临床症状、术前及术后激素水平、手术方式、手术时长和随访时间;收集患者肿瘤的体积、术前是否发生瘤卒中、Knosp分级、质地和切除程度.采用单因素和多因素logistic回归分析(向后剔除法)判断术后垂体功能减退的影响因素.结果1210例患者中,617例(51.0%)术后存在垂体功能减退.1210例患者的随访时间[M(Q_(1),Q_(3))]为6.5(3.0,11.2)个月.单因素logistic回归分析结果显示,术前发生瘤卒中、术前垂体功能减退、肿瘤体积以及手术时长均是患者术后垂体功能减退的影响因素(均P<0.05).多因素logistic回归分析结果显示,术前发生瘤卒中(OR=1.96,95%CI:1.20~3.26,P=0.008)、术前垂体功能减退(OR=2.89,95%CI:2.09~4.05,P<0.001)以及肿瘤体积较大(OR=1.02,95%CI:1.00~1.03,P=0.015)均是术后垂体功能减退的危险因素.结论术前垂体功能减退、肿瘤体积较大、发生瘤卒中的无功能垂体神经内分泌肿瘤患者,术后垂体功能减退的风险较高.Objective To explore the influencing factors of hypopituitarism after surgery for non-functioning pituitary neuroendocrine tumors.Methods A retrospective analysis was conducted on the clinical data of non-functioning pituitary neuroendocrine tumors registered by the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2022 in China's National Brain Tumor Registration Platform.A total of 1210 patients were included.The patient's age,gender,clinicalsymptoms,preoperative and postoperative hormone levels,surgical method,surgical duration and follow-up time were collected.The patient's tumor volume,preoperative tumor apoplexy,Knosp grade,texture and extent of resection were collected.Univariate and multivariate logistic regression analyses(backward elimination method)were used to determine the influencing factors of postoperative hypopituitarism.Results Among 1210 patients,617(51.0%)had hypopituitarism after surgery.The follow-up time[M(Q_(1),Q_(3))]of 1210 patients was 6.5(3.0-11.2)months.The results of univariate logistic regression analysis showed that preoperative tumor apoplexy,preoperative hypopituitarism,tumor volume and operation duration were all influencing factors of postoperative hypopituitarism(all P<0.05).The results of multivariate logistic regression analysis showed that preoperative tumor apoplexy(OR=1.96,95%CI:1.20-3.26,P=0.008)and preoperative hypopituitarism(OR=2.89,95%CI:2.09-4.05,P<0.001)and larger tumor size(OR=1.02,95%CI:1.00-1.03,P=0.015)were risk factors for postoperative hypopituitarism.Conclusion Patients with non-functioning pituitary neuroendocrine tumors who have preoperative hypopituitarism,large tumor size,and tumor apoplexy have a higher risk of postoperative hypopituitarism.

关 键 词：垂体肿瘤神 经外科手术 垂体功能减退症 影响因素分析 

分 类 号：R736.4[医药卫生—肿瘤]