摘要
目的探讨术后血促肾上腺皮质激素（ACTH）水平在评估库欣病术后疗效中的价值。方法回顾性分析2012年1月至2014年12月中国医学科学院，北京协和医学院，北京协和医院神经外科行手术治疗的208例库欣病患者的临床资料，包括患者的年龄、性别、术前MRI表现、肿瘤大小、原发或复发情况以及围手术期内分泌指标。根据术后血皮质醇水平将208例库欣病患者分为内分泌早期缓解组（简称早期缓解组，143例）和未缓解组（65例）。采用单因素分析和多因素Logistic回归分析方法探讨影响库欣病患者术后内分泌早期缓解的因素。绘制ROC曲线分析相应内分泌指标判断库欣病患者术后早期疗效的准确性。结果单因素分析结果显示，早期缓解组和未缓解组在术前血ACTH、术后ACTH方面的差异均存在统计学意义（P=0．028，P〈0．001）。多因素Logistic回归分析显示，术后ACTH为库欣病患者术后内分泌早期缓解的影响因素（OR=0．955，95％CI：0．939～0．972，P〈0．001）。ROC曲线分析显示，术后血ACTH的预测最佳临界值为18．85pg／ml，曲线下面积为0．900（95％CI：0．855—0．945，P〈0．001），灵敏度为78．5％，特异性为88．1％。结论血ACTH为可评价库欣病术后早期疗效的指标之一，术后晨起血ACTH〈18．85gp/ml时提示内分泌缓解，但其对长期疗效的预测作用尚不明确。
Objective To explore the prognostic value of plasma ACTH in predicting the outcome of patients with Cushing＇ s disease after operations. Methods The clinical data of 208 patients with Cushing＇s disease treated with neurosurgery at the Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences from January 2012 to December 2014 were analyzed retrospectively, including the patients＇ age, gender, preoperative MRI findings, tumor size, primary or recurrent condition, as well as perioperative endocrine indicators. The 208 patients with Cushing＇ s disease were divided into either an early endocrine remission group （ briefly early remission group） or a non-remission group according to their postoperative serum cortisol levels. Univariate analysis and multivariate Logistic regression analysis were used to investigate the factors affecting the early postoperative endocrine remission in patients with Cushing＇s disease. The receiver operating characteristic （ROC） curve was drawn, and the corresponding endocrine indices were analyzed and the accuracy of early postoperative efficacy was identified. Results Univariate factor analysis showed that there were statistical differences in preoperative and postoperative ACTH between the early endocrine remission group and the non-remission group （ P = 0. 028, P 〈 0. 001 ）. Multivariate Logistic regression analysis showed that the postoperative ACTH was an influencing factor of early remission in patients with Cushing＇ s disease （ OR, 0. 955, 95% CI O. 939 -0.972 ,P 〈 0.001 ）. ROC curve analysis showed that the optimal critical value of the prediction of ACTH after procedure was 18.85 pg/ml. The area under the curve was 0.900 （95% C10. 855 - 0. 945, P 〈 0. 001 ）. The sensitivity was 78.5% and the specificity was 88. 1%. Condusions The postoperative plasma ACTH is one of the indicators of early efficacy for evaluating Cushing＇ s disease after procedure. When early mornin
作者
冯铭
杨程显
刘小海
包新杰
邓侃
幸兵
朱惠娟
卢琳
姚勇
王任直
Feng Ming Yang Chengxian Liu Xiaohai Bao Xinjie Deng Kan Xing Bing Zhu Huijuan Lu Lin Yao Yong Wang Renzhi(Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College ＆ Chinese Academy of Medical Sciences, Beijing 100730, China)
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第3期270-274,共5页
Chinese Journal of Neurosurgery
关键词
垂体肿瘤
库欣病
神经外科手术
治疗结果
Pituitary neoplasms
Cushing＇s disease
Neurosurgical procedures
Treatment outcome
