神经内镜下经蝶垂体腺瘤切除术后迟发性低钠血症的预测模型研究  

Predictive model for delayed hyponatremia after endoscopic transsphenoidal surgery of pituitary adenomas

作　　者：裴玉康 董峻东 张桐 陈洪福 杨烈驰 苗发安 PEI Yukang;DONG Jundong;ZHANG Tong;CHEN Hongfu;YANG Liechi;MIAO Fa’an(Department of Neurosurgery,Department of Skull Base Oncology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院神经外科颅底肿瘤外科,江苏徐州221002

出　　处：《中国肿瘤外科杂志》2024年第3期246-252,共7页Chinese Journal of Surgical Oncology

基　　金：国家自然科学基金(82002632)。

摘　　要：目的探讨经蝶手术治疗垂体腺瘤患者术后发生迟发性低钠血症(DPH)的危险因素。方法回顾性分析徐州医科大学附属医院颅底肿瘤外科2018年1月至2022年12月105例经蝶垂体腺瘤切除术患者的临床、实验室及影像资料,采用单因素分析及多因素Logistic回归分析两组患者的资料,确定DPH的危险因素,并建立预测列线图,应用受试者工作特征曲线下面积(AUC)、校准曲线及决策曲线(DCA)进行评估。结果105例接受经蝶垂体腺瘤切除术的患者中,32例术后发生DPH,发生率为30.4%,多因素Logistic回归分析示纳入术前泌乳素水平、术前鞍膈上抬高度及术后第1~2天低血钠3个危险因素构建列线图,训练集和验证集预测术后DPH的AUC分别为0.886、0.869,DCA曲线显示在临床应用中能收获较高收益。结论术前泌乳素水平较高、术前鞍膈上抬较高及术后第1~2天出现低钠血症的患者,术后更易发现DPH,以此构建的列线图模型对术后DPH的发生具有一定预测价值。Objective This study is to explore the potential risks of delayed hyponatremia after transsphenoidal surgery for pituitary adenomas.Methods The clinical,laboratory and imaging data of 105 patients undergoing transsphenoidal pituitary adenoma resection in the Department of Skull Base Oncology,Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2022 were investigated retrospectively.Analyses of univariate and multivariate Logistic regression were conducted to ascertain the risk factors associated with delayed hyponatremia and to create predictive nomogram.The area under receiver operating curve(ROC),calibration curve,and decision curve analysis were employed to evaluate.Results Out of 105 patients who had undergone transsphenoidal resection of pituitary adenomas,32 cases developed delayed hyponatremia after operation,with an incidence rate of 30.4%.Three risk factors:preoperative prolactin level,preoperative elevation of diaphragma sellae and hyponatremia 1-2 days after operation were included to construct the nomogram.The AUC for forecasting delayed postoperative hyponatremia(DPH)in training and validation sets was 0.886 and 0.869 respectively.The DCA curve indicated a higher benefit in clinical application.Conclusions Patients with higher preoperative prolactin levels,elevated preoperative diaphragma sellae,and the occurrence of hyponatremia within the first 1-2 days after surgery are more likely to develop DPH.A nomogram prognostic model for predicting DPH was constructed and validated,which can provide more accurate reference basis for treatment decision.

关 键 词：垂体腺瘤 经蝶手术 迟发性低钠血症 磁共振成像 危险因素 列线图 

分 类 号：R736.4[医药卫生—肿瘤]