术后GH与IGF-1水平对非侵袭性垂体生长激素腺瘤远期缓解的预测价值

doi:10.6040/j.issn.1673-3770.0.2024.510

摘要/Abstract

摘要： 目的探讨内镜下经蝶入路手术在非侵袭性垂体生长激素(growth hormone, GH)腺瘤治疗中的疗效,并分析术后GH和胰岛素样生长因子-1(insulin-like growth factor-1, IGF-1)水平对远期激素生化缓解的预测价值。方法回顾性收集2012年10月15日至2024年8月19日我院收治并接受经蝶入路内镜手术的38例非侵袭性垂体GH瘤患者的临床资料,分析影响远期缓解的因素。采用受试者工作特征(receiver operating characteristic, ROC)曲线评估术后第1天的GH、IGF-1水平和术后IGF-1/术前IGF-1比值的预测效能。结果 38例患者中26例达到远期生化缓解,远期缓解率为68.4%。远期缓解组的术后第1天GH(P<0.001)、IGF-1水平(P=0.026)及术后IGF-1/术前IGF-1比值(P=0.003)均显著低于未缓解组。ROC曲线分析显示,术后GH、IGF-1水平和术后IGF-1/术前IGF-1比值的曲线下面积分别为0.904、0.789和0.839。当术后第一天GH水平<1.66 ng/mL时,预测患者远期缓解的敏感度为91.7%,特异度为84.6%;当术后IGF-1/术前IGF-1<75.8%时,预测患者远期缓解的敏感度为75.0%,特异度为85.7%。结论内镜下经蝶入路手术可有效治疗非侵袭性垂体GH腺瘤。术后第1天GH、IGF-1水平和术后IGF-1/术前IGF-1比值较低的患者更易获得远期生化缓解,其中术后GH水平的预测价值最高。

关键词: 垂体生长激素腺瘤, 生长激素, 胰岛素样生长因子-1, 内镜手术, 远期缓解

Abstract: Objective To investigate the clinical efficacy of endoscopic transsphenoidal surgery in the treatment of non-invasive growth hormone(GH)-secreting pituitary adenoma, and to analyze the predictive value of postoperative GH and insulin-like growth factor-1(IGF-1)levels for long-term hormonal biochemical remission. Methods The clinical data of 38 patients with non-invasive GH-secreting pituitary adenoma who underwent endoscopic transsphenoidal surgery at our institution from October 2012 to August 2024 were retrospectively collected and factors influencing long-term remission were analyzed. Receiver operating characteristic(ROC)curves were used to evaluate the predictive performance of GH and IGF-1 levels on the postoperative day 1, as well as the postoperative IGF-1/preoperative IGF-1 ratio. Results Among the 38 patients included in the study,26 achieved long-term biochemical remission, with a remission rate of 68.4%. Compared to the non-remission group, the remission group had significantly lower GH levels(P<0.001), IGF-1 levels(P=0.026)on the postoperative day 1, and a lower postoperative IGF-1/preoperative IGF-1 ratio(P=0.003). ROC analysis revealed that the area under the curve(AUC)for postoperative GH, IGF-1, and the IGF-1 ratio were 0.904, 0.789, and 0.839, respectively. A postoperative GH level of <1.66 ng/mL was found to predict long-term remission with a sensitivity of 91.7% and a specificity of 84.6%, while a postoperative IGF-1/preoperative IGF-1 ratio of <75.8% was found to predict remission with a sensitivity of 75.0% and a specificity of 85.7%. Conclusion The endoscopic transsphenoidal surgery is an effective treatment for non-invasive GH-secreting pituitary adenoma. Patients exhibiting lower postoperative GH and IGF-1 levels, as well as a lower postoperative IGF-1/ preoperative IGF-1 ratio, are more likely to achieve long-term biochemical remission. Of these, postoperative GH levels demonstrated the highest predictive value.

Key words: Growth hormone-secreting pituitary adenoma, Growth hormone, Insulin-like growth factor-1, Endoscopic surgery, Long-term remission

中图分类号:

R739.41

顾月龙,唐如,茆松,张维天. 术后GH与IGF-1水平对非侵袭性垂体生长激素腺瘤远期缓解的预测价值[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 45-50.

GU Yuelong, TANG Ru, MAO Song, ZHANG Weitian. Predictive value of postoperative GH and IGF-1 levels for long-term remission in non-invasive growth hormone-secreting pituitary adenoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(3): 45-50.

参考文献

[1] Gheorghiu ML. News in acromegaly[J]. Acta Endocrinol(Buchar), 2017, 13(1): 129-130. doi:10.4183/aeb.2017.129
[2] 中国垂体腺瘤协作组. 中国肢端肥大症诊治共识(2021版)[J]. 中华医学杂志, 2021, 101(27): 2115-2126. doi: 10.3760/cma.j.cn112137-20210106-00022
[3] Zhang S, Chen J, Yao S, et al. Predictors of postoperative biochemical remission in lower Knosp grade growth hormone-secreting pituitary adenomas: a large single center study[J]. J Endocrinol Invest, 2023, 46(3): 465-476. doi:10.1007/s40618-022-01873-9
[4] Guo XP, Zhang RP, Zhang DX, et al. Determinants of immediate and long-term remission after initial transsphenoidal surgery for acromegaly and outcome patterns during follow-up: a longitudinal study on 659 patients[J]. J Neurosurg, 2022, 137(3): 618-628. doi:10.3171/2021.11.JNS212137
[5] Knosp E, Steiner E, Kitz K, et al. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings[J]. Neurosurgery, 1993, 33(4): 610-617; discussion 617-618. doi:10.1227/00006123-199310000-00008
[6] Wilson CB. Neurosurgical management of large and invasive pituitary tumors[J]. Clinical Management of Pituitary Disorders, 1977: 335-342
[7] Guinto G, Guinto-Nishimura GY, Uribe-Pacheco R, et al. Surgical outcomes in patients with acromegaly: microscopic vs. endoscopic transsphenoidal surgery[J]. Best Pract Res Clin Endocrinol Metab, 2024, 38(4): 101879. doi:10.1016/j.beem.2024.101879
[8] Mohyeldin A, Katznelson LJ, Hoffman AR, et al. Prospective intraoperative and histologic evaluation of cavernous sinus medial wall invasion by pituitary adenomas and its implications for acromegaly remission outcomes[J]. Sci Rep, 2022, 12(1): 9919. doi:10.1038/s41598-022-12980-1
[9] Giustina A, Biermasz N, Casanueva FF, et al. Consensus on criteria for acromegaly diagnosis and remission[J]. Pituitary, 2024, 27(1): 7-22. doi:10.1007/s11102-023-01360-1
[10] Fleseriu M, Langlois F, Lim DST, et al. Acromegaly: pathogenesis, diagnosis, and management[J]. Lancet Diabetes Endocrinol, 2022, 10(11): 804-826. doi:10.1016/S2213-8587(22)00244-3
[11] Cambria V, Beccuti G, Prencipe N, et al. First but not second postoperative day growth hormone assessments as early predictive tests for long-term acromegaly persistence[J]. J Endocrinol Invest, 2021, 44(11): 2427-2433. doi:10.1007/s40618-021-01553-0
[12] Cardinal T, Collet C, Wedemeyer M, et al. Postoperative GH and degree of reduction in IGF-1 predicts postoperative hormonal remission in acromegaly[J]. Front Endocrinol(Lausanne), 2021, 12: 743052. doi:10.3389/fendo.2021.743052
[13] Balagurunath K, Chrenek R, Gerstl J, et al. Predictors of biochemical remission after transsphenoidal surgery in a large cohort of acromegaly patients[J]. Pituitary, 2024, 28(1): 2. doi:10.1007/s11102-024-01472-2
[14] Coopmans EC, Postma MR, Wolters TLC, et al. Predictors for remission after transsphenoidal surgery in acromegaly: a Dutch multicenter study[J]. J Clin Endocrinol Metab, 2021, 106(6): 1783-1792. doi:10.1210/clinem/dgab069
[15] Asa SL, Mete O, Perry A, et al. Overview of the 2022 WHO classification of pituitary tumors[J]. Endocr Pathol, 2022, 33(1): 6-26. doi:10.1007/s12022-022-09703-7
[16] Vuong HG, Dunn IF. Clinical and prognostic significance of granulation patterns in somatotroph adenomas/tumors of the pituitary: a meta-analysis[J]. Pituitary, 2023, 26(6): 653-659. doi:10.1007/s11102-023-01353-0
[17] Rick J, Jahangiri A, Flanigan PM, et al. Growth hormone and prolactin-staining tumors causing acromegaly: a retrospective review of clinical presentations and surgical outcomes[J]. J Neurosurg, 2019, 131(1): 147-153. doi:10.3171/2018.4.jns18230

相关文章 15

[1]	陈兴雪,张广玲,武天义,王卫卫,孙占伟,李世超,王广科. 抗IL-4Rα单克隆抗体与鼻内镜手术治疗嗜酸性粒细胞型慢性鼻窦炎伴鼻息肉的疗效分析[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 43-54.
[2]	袁玥,庞文会,陈敏,付圣尧,于龙刚,孙钰博,李玲玲. 毛霉菌性鼻窦炎25例临床特征分析[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 102-107.
[3]	鲁欢,何本超,廖红明. 儿童急性鼻窦炎合并眶眼蜂窝织炎并发颅内感染1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(1): 46-50.
[4]	徐宏鸣,范文焱,浦诗磊,李晓艳. 儿童上颌窦后鼻孔息肉36例临床资料分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 159-163.
[5]	吕萍,李丹丹,宋伟,洪流. 鼻内镜辅助下鼻泪道再通术治疗新生儿期泪囊炎[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 71-74.
[6]	资昊坤,肖旭平,李云秋. 口服糖皮质激素在慢性鼻窦炎伴鼻息肉围手术期的应用现状[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 98-103.
[7]	秦铭,孙占伟,王卫卫,李世超,武天义,王广科. 咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 147-153.
[8]	陈坤,陆慧,黄琦,李磊,孟国珍,杨军,侯东明. 小儿先天性鼻腔鼻窦肿物的临床诊疗观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 81-85.
[9]	吴泽斌,邱前辉. 儿童颅底病变和内镜手术[J]. 山东大学耳鼻喉眼学报, 2021, 35(3): 112-117.
[10]	王再兴,唐志元,赵海亮,刘智献,李定波,李胜,马世博,卢永田. 电磁导航引导筛窦球囊成形术精准治疗慢性筛窦炎10例[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 61-68.
[11]	张金庄,殷璞,刘宁,王江宇,贾云芬,丁元吉,吴垚. FESS术后加用香菊胶囊与康复新液治疗慢性鼻窦炎伴有鼻息肉的对比研究[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 69-76.
[12]	陈坤,李磊,孟国珍,杨军,侯东明. 婴幼儿先天性基底型脑膜脑膨出的诊断及鼻内镜手术治疗[J]. 山东大学耳鼻喉眼学报, 2021, 35(1): 77-81.
[13]	王磊,袁英,于学民,韩玉娥,王宁,李晓,李龙,侯妮妮. 鼻内镜手术治疗上颌骨囊肿的临床分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 31-35.
[14]	张伟,刘勇刚,江玲燕. 功能性鼻内窥镜术后慢性鼻窦炎患者短期布地奈德盐水盥洗疗效观察[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 128-130.
[15]	宋晓宇, 张宇, 李成林, 宋西成. 加速康复外科理念在慢性鼻-鼻窦炎伴鼻息肉手术治疗中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 9-12.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed