海绵间窦引流模式对双侧岩下窦取样预测库欣病肿瘤侧别的影响  

Influence of cavernous sinus venous drainage patterns on the prediction of tumor laterality in Cushing′s disease via bilateral inferior petrosal sinus sampling

作　　者：焦贺男 朱旭强[1] 陈迪[1] 高鹏 吴力新[1] 李雪元 闫东明[1] Jiao Henan;Zhu Xuqiang;Chen Di;Gao Peng;Wu Lixin;Li Xueyuan;Yan Dongming(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》2025年第1期31-36,共6页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划(LHGJ20230239,SBGJ202402043)。

摘　　要：目的探讨海绵间窦引流模式对双侧岩下窦取样(BIPSS)预测库欣病患者肿瘤侧别的影响。方法回顾性分析郑州大学第一附属医院神经外科2018年8月至2024年2月期间实施BIPSS的65例库欣病患者的临床资料。根据数字减影血管造影结果判断海绵间窦引流模式,分为对称引流和不对称引流。根据岩下窦(IPS)与外周血促肾上腺皮质激素(ACTH)的比值(IPS/外周血ACTH)预判肿瘤侧别,采用连续校正χ^(2)检验分析其与经蝶手术中所见肿瘤侧别的相关性,并采用Fisher精确检验分别分析对称引流或不对称引流患者中两者的相关性。采用Apriori算法对非优势侧IPS/外周血ACTH<1、非优势侧IPS/外周血ACTH≥1、肿瘤位于优势侧、肿瘤位于非优势侧4个事务项进行关联分析。结果65例库欣病患者中,经蝶手术证实肿瘤位于左侧28例(43.1%),位于右侧36例(55.4%),居中1例(1.5%);BIPSS结果显示,肿瘤位于左侧23例(35.4%),右侧39例(60.0%),居中3例(4.6%);连续校正χ^(2)检验结果显示,BIPSS预测肿瘤侧别与手术证实肿瘤侧别相关(校正χ^(2)=34.93,P<0.001)。海绵间窦不对称引流25例(右侧优势16例,左侧优势9例),对称引流40例。40例对称引流患者中,BIPSS预测结果与手术证实肿瘤侧别一致者37例(准确率为92.5%);25例不对称引流患者中,BIPSS预测结果与手术证实肿瘤侧别一致者10例(准确率为40.0%);准确率的差异具有统计学意义(校正χ^(2)=4.60,P<0.001)。Fisher精确检验显示,对称引流时BIPSS预测肿瘤侧别与手术证实肿瘤侧别相关(P<0.001);不对称引流时BIPSS预测肿瘤侧别与手术证实肿瘤侧别无相关关系(P=0.411),但非优势侧IPS/外周血ACTH是否≥1与肿瘤侧别具有相关性(P<0.001)。进一步关联分析结果显示,非优势侧IPS/外周血ACTH≥1时肿瘤位于非优势侧,非优势侧IPS/外周ACTH均值<1时肿瘤位于优势侧是两个强关联规则。结论海绵间窦引流模式可影响BIPSS对库Objective To explore the impact of cavernous sinus(CS)venous drainage patterns on the prediction of tumor laterality in patients with Cushing′s disease through bilateral inferior petrosal sinus sampling(BIPSS).Methods A retrospective analysis was conducted on the clinical data of 65 Cushing′s disease patients who underwent BIPSS at the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University from August 2018 to February 2024.Based on digital subtraction angiography,the CS drainage patterns were categorized as symmetric or asymmetric.Tumor laterality was predicted according to the ratio of adrenocorticotropic hormone(ACTH)level in the inferior petrosal sinus(IPS)to that in the peripheral blood(IPS/peripheral ACTH).The association between predicted tumor laterality and intraoperative findings was analyzed using the continuous correctionχ^(2)test.Fisher′s exact test was employed to analyze correlations for symmetric and asymmetric drainage groups separately.Association analysis was performed with the Apriori algorithm on four transactional items:non-dominant side IPS/peripheral ACTH<1,non-dominant side IPS/peripheral ACTH≥1,tumor on the dominant side,and tumor on the non-dominant side.Results Among the 65 Cushing′s disease patients,intraoperative findings showed left-sided tumors in 28 cases(43.1%),right-sided tumors in 36 cases(55.4%),and a midline tumor in 1 case(1.5%).BIPSS results indicated left-sided tumors in 23 cases(35.4%),right-sided tumors in 39 cases(60.0%),and midline tumors in 3 cases(4.6%).The continuous correctionχ^(2)test indicated a significant correlation between BIPSS-predicted and intraoperatively confirmed tumor laterality(χ^(2)=34.93,P<0.001).Among the 25 cases with asymmetric drainage(16 with right dominance and 9 with left dominance)and 40 cases with symmetric drainage,BIPSS predictions matched the intraoperative tumor laterality in 37 symmetric cases(accuracy:92.5%)and in 10 asymmetric cases(accuracy:40.0%),with a statistically significant difference(adju

关 键 词：岩下窦取样 库欣病 肿瘤侧别 海绵间窦引流模式 

分 类 号：R736.4[医药卫生—肿瘤]