本文選題：垂體瘤 + ACTH垂體腺瘤��； 參考：《吉林大學》2017年碩士論文

【摘要】：目的:本研究通過對接受經(jīng)鼻蝶垂體瘤切除術后患者的臨床基本特征進行分析,探討垂體瘤患者臨床病理特征與術后發(fā)生一過性低鉀血癥的相關性,進一步揭示一過性低血鉀的危險因素,為個體化術后低鉀血癥的預防及治療提供科學的理論依據(jù)。方法:本研究回顧性收集了2014年9月至2017年4月就診于吉林大學第一醫(yī)院神經(jīng)腫瘤外科且被診斷為垂體瘤的患者共257例,納入研究隊列。所有納入對象均接受經(jīng)鼻蝶垂體瘤切除術,且由同一外科醫(yī)生進行腫瘤切除。在數(shù)據(jù)統(tǒng)計分析過程中,計量資料且呈正態(tài)分布數(shù)據(jù)采用Student's t檢驗或ANOVA比較,采用卡方或Fisher精確檢驗比較計數(shù)資料的數(shù)據(jù)分布特點。采用非條件Logistic回歸分析垂體瘤患者臨床特征與術后發(fā)生一過性低血鉀的優(yōu)勢比(OR)值及95%可信區(qū)間(confidence intervals,CIs)。應用多因素非條件Logistic回歸分析垂體瘤患者術后發(fā)生一過性低鉀血癥的獨立危險因素。此外,重復測量ANOVA用于分析血清鉀離子水平隨時間的變化特征。應用SPSS18.0軟件(SPSS Inc.,USA)對所有統(tǒng)計量進行評估。雙側檢驗P0.05被認為有統(tǒng)計學差異。結果:(1)本研究共納入垂體瘤患者257例,其發(fā)生術后低血鉀患者22例,所有納入研究對象的手術平均年齡45.9±13.0歲,其中男性115例,平均年齡47.0歲(17-81歲),女性142例,平均年齡45.1歲(14-68歲)。我們所納入研究隊列的257例受試者,99例(38.5%)為無功能垂體瘤,158例(61.5%)為功能型垂體瘤,功能型垂體瘤根據(jù)其內(nèi)分泌學特點,70例(27.2%)為PRL型垂體瘤、41例(16.0%)為GH型垂體瘤、20例(7.8%)為ACTH型垂體瘤、10例(3.9%)為FSH型垂體瘤以及5例(1.9%)為TSH型垂體瘤。(2)在進行單因素非條件Logistic回歸分析垂體瘤患者術后一過性低血鉀危險因素的相關性分析中,垂體瘤患者的籍貫(農(nóng)村vs.城市)、術后住院時間長短(12天vs.≥12天)、患者是否伴有高血壓,垂體瘤是否為ACTH型腺瘤是影響垂體瘤患者術后是否發(fā)生一過性低血鉀的因素。結果提示,住院天數(shù)12天的患者術后發(fā)生一過性低血鉀的風險是住院天數(shù)12天垂體瘤患者的2.80倍(OR=2.80,95%CI:1.15-6.83,P=0.024);與此同時,來自于城市的患者相比較于農(nóng)村的患者,其術后發(fā)生低血鉀風險為0.30倍(OR=0.30,95%CI:0.11-0.85,P=0.023);此外,垂體瘤伴有高血壓的患者其術后發(fā)生低血鉀的風險是非高血壓垂體瘤患者的5.03倍(OR=5.03,95%CI:2.04-12.41,P0.001);最后ACTH型垂體瘤患者較非ACTH患者術后更易發(fā)生一過性低鉀血癥(nonACTH-pituitary adenomas vs.ACTH-pituitary adenomas:OR=18.75,95%CI:6.55-53.66,P0.001)。(3)在探索影響垂體瘤患者術后發(fā)生一過性低鉀血癥的獨立影響因素時,我們將單因素非條件Logistic回歸分析中對垂體瘤患者術后發(fā)生一過性低鉀血癥有影響的所有因素包括患者的住院天數(shù)、籍貫、是否為ACTH型垂體腺瘤及是否伴有高血壓等因素納入多因素Logistic回歸分析中,結果顯示,功能型垂體腺瘤和ACTH型垂體腺瘤是患者術后發(fā)生一過性低鉀血癥的獨立危險因素(non-ACTH-pituitary adenomas vs.ACTH-pituitary adenomas:OR=6.54,95%CI:1.76-24.33,P=0.005)。(4)為進一步驗證垂體瘤致患者術后發(fā)生一過性低鉀血癥危險因素,我們詳細探討了22例垂體瘤患者發(fā)生術后低血鉀患者的臨床病理分型,其中ACTH垂體腺瘤10例(45.5%),另外12例發(fā)生術后一過性低鉀的患者包括5例PRL垂體腺瘤、3例GH垂體腺瘤、2例無功能垂體腺瘤、1例FSH垂體腺瘤、1例TSH垂體腺瘤以及1例混合型垂體腺瘤。我們將樣本分為ACTH垂體腺瘤組(ACTH組)和非ACTH垂體腺瘤(對照組),按重復測量資料方差分析原理探索影響垂體瘤患者術后發(fā)生一過性低鉀的危險因素,結果顯示,ACTH型垂體瘤患者術后容易發(fā)生一過性低鉀具有統(tǒng)計學意義(P=0.005)。結論:垂體瘤分型為ACTH垂體腺瘤是術后發(fā)生一過性低鉀的獨立危險因素,臨床工作中應著重監(jiān)測ACTH垂體腺瘤患者術后血鉀濃度變化,如果發(fā)生低血鉀現(xiàn)象則立即體外補鉀,最大程度的減少垂體瘤患者術后并發(fā)癥,提高患者生活質(zhì)量、減少患者住院時間。
[Abstract]:Objective: To explore the correlation between the clinicopathological features of the patients with pituitary adenoma and the incidence of hyperkalemia after surgery, and to further reveal the risk factors of hyperkalemia, and to provide a scientific basis for the prevention and treatment of hypokalemia after individual operation. Methods: This study retrospectively collected 257 patients who were diagnosed as pituitary tumor surgery in No.1 Hospital of Jilin University from September 2014 to April 2017, and included the cohort. All the subjects received transsphenoidal pituitary adenoma resection, and the same surgeon performed tumor resection. In the process of analysis, the measurement data and the normal distribution data were compared with the Student's t test or the ANOVA comparison. Chi square or Fisher was used to accurately test the data distribution characteristics of the count data. The clinical features of the pituitary tumor patients were analyzed by the unconditional Logistic regression and the dominance ratio (OR) and 95% confidence interval of the postoperatively a hypophyseal hypokalemia (OR). Confidence intervals, CIs). An independent risk factor for hypophyseal hypophysis patients with hypophyseal hypophysis after surgery was analyzed by multifactor non conditional Logistic regression. In addition, repeated measurements of ANOVA were used to analyze the changes in serum potassium levels with time. All statistics were evaluated with SPSS18.0 software (SPSS Inc., USA). Bilateral tests were performed on both sides. Results: P0.05 was considered to be statistically different. Results: (1) 257 cases of hypophysis tumor were included in this study, and 22 patients with hypokalemia after operation. The average age of all the subjects was 45.9 + 13 years old, including 115 men, 47 years old (17-81 years), 142 women and 45.1 years old (14-68 years old). We included the research team. In the 257 subjects, 99 (38.5%) were nonfunctional pituitary tumors and 158 (61.5%) were functional pituitary tumors. Functional hypophysis was based on its endocrinology, 70 (27.2%) was PRL pituitary tumor, 41 (16%) was GH pituitary tumor, 20 (7.8%) was ACTH type, 10 (3.9%) was FSH pituitary tumor and TSH type pituitary tumor. A single factor unconditional Logistic regression analysis was used to analyze the correlation analysis of the risk factors for hypophysis patients with hyperkalemia after surgery, the native place of the pituitary tumor (rural vs. city), the length of hospitalization after the operation (12 days vs. > 12 days), whether the patient was accompanied by hypertension, and whether the pituitary tumor was ACTH type adenoma The results suggested that the risk of hypokalemia after 12 days of hospitalization was 2.80 times (OR=2.80,95%CI:1.15-6.83, P=0.024) of hypophysis patients after 12 days of hospitalization (OR=2.80,95%CI:1.15-6.83, P=0.024); at the same time, the risk of hypokalemia in the patients from the city was 0.30 times higher than that of the rural patients (OR =0.30,95%CI:0.11-0.85, P=0.023); in addition, the risk of postoperative hypokalemia in patients with hypophysis with hypertension was 5.03 times (OR=5.03,95%CI:2.04-12.41, P0.001) in patients with non hypertensive pituitary adenomas; in the end, patients with type ACTH pituitary adenomas were more likely to have hyperkalemia than non ACTH patients (nonACTH-pituitary adenomas vs.ACTH-pi). Tuitary adenomas:OR=18.75,95%CI:6.55-53.66, P0.001). (3) in exploring the independent factors affecting hypophysis patients with hyperkalemia after surgery, all factors affecting the postoperative hyperkalemia in patients with pituitary adenomas included in the single factor non conditional Logistic regression analysis, including the number of patients' hospitalization days, The results showed that functional pituitary adenomas and ACTH pituitary adenomas were independent risk factors for the occurrence of hyperkalemia (non-ACTH-pituitary adenomas vs.ACTH-pituitary adenomas:OR=6.54,95%CI:1.76-2) in patients with ACTH type pituitary adenomas and whether they were associated with hypertension. 4.33, P=0.005. (4) to further verify the risk factors for hyperkalemia in patients with pituitary adenoma after operation, we examined the clinicopathological features of 22 patients with hypophysiohypophysis after surgery, including 10 cases of ACTH pituitary adenomas (45.5%), and 12 patients with hyperkalemia after operation including 5 PRL pituitary adenomas, 3 GH pituitary adenoma, 2 non functional pituitary adenomas, 1 FSH pituitary adenomas, 1 TSH pituitary adenomas and 1 mixed pituitary adenomas. We divided the samples into ACTH pituitary adenoma group (ACTH group) and non ACTH pituitary adenoma (control group), and explored the risk of hypophysis patients with hypophyseal hypokalemia after operation according to the principle of variance analysis. Risk factors, the results show that patients with ACTH pituitary adenoma are prone to have a hypophyseal hypokalemia after operation (P=0.005). Conclusion: pituitary adenoma type ACTH pituitary adenoma is an independent risk factor for postoperatively a hypophyseal hypokalemia. Clinical work should focus on monitoring the change of blood potassium concentration in patients with ACTH pituitary adenoma, if hypoemia occurs. Potassium can immediately supplement potassium in vitro, reduce the postoperative complications, improve the quality of life and reduce the length of stay in patients with pituitary adenoma.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R736.4

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