经鼻蝶垂体瘤切除术患者术后一过性低血钾相关危险因素分析

发布时间：2018-07-06 19:34

本文选题：垂体瘤 + ACTH垂体腺瘤　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:本研究通过对接受经鼻蝶垂体瘤切除术后患者的临床基本特征进行分析,探讨垂体瘤患者临床病理特征与术后发生一过性低钾血症的相关性,进一步揭示一过性低血钾的危险因素,为个体化术后低钾血症的预防及治疗提供科学的理论依据。方法:本研究回顾性收集了2014年9月至2017年4月就诊于吉林大学第一医院神经肿瘤外科且被诊断为垂体瘤的患者共257例,纳入研究队列。所有纳入对象均接受经鼻蝶垂体瘤切除术,且由同一外科医生进行肿瘤切除。在数据统计分析过程中,计量资料且呈正态分布数据采用Student's t检验或ANOVA比较,采用卡方或Fisher精确检验比较计数资料的数据分布特点。采用非条件Logistic回归分析垂体瘤患者临床特征与术后发生一过性低血钾的优势比(OR)值及95%可信区间(confidence intervals,CIs)。应用多因素非条件Logistic回归分析垂体瘤患者术后发生一过性低钾血症的独立危险因素。此外,重复测量ANOVA用于分析血清钾离子水平随时间的变化特征。应用SPSS18.0软件(SPSS Inc.,USA)对所有统计量进行评估。双侧检验P0.05被认为有统计学差异。结果:(1)本研究共纳入垂体瘤患者257例,其发生术后低血钾患者22例,所有纳入研究对象的手术平均年龄45.9±13.0岁,其中男性115例,平均年龄47.0岁(17-81岁),女性142例,平均年龄45.1岁(14-68岁)。我们所纳入研究队列的257例受试者,99例(38.5%)为无功能垂体瘤,158例(61.5%)为功能型垂体瘤,功能型垂体瘤根据其内分泌学特点,70例(27.2%)为PRL型垂体瘤、41例(16.0%)为GH型垂体瘤、20例(7.8%)为ACTH型垂体瘤、10例(3.9%)为FSH型垂体瘤以及5例(1.9%)为TSH型垂体瘤。(2)在进行单因素非条件Logistic回归分析垂体瘤患者术后一过性低血钾危险因素的相关性分析中,垂体瘤患者的籍贯(农村vs.城市)、术后住院时间长短(12天vs.≥12天)、患者是否伴有高血压,垂体瘤是否为ACTH型腺瘤是影响垂体瘤患者术后是否发生一过性低血钾的因素。结果提示,住院天数12天的患者术后发生一过性低血钾的风险是住院天数12天垂体瘤患者的2.80倍(OR=2.80,95%CI:1.15-6.83,P=0.024);与此同时,来自于城市的患者相比较于农村的患者,其术后发生低血钾风险为0.30倍(OR=0.30,95%CI:0.11-0.85,P=0.023);此外,垂体瘤伴有高血压的患者其术后发生低血钾的风险是非高血压垂体瘤患者的5.03倍(OR=5.03,95%CI:2.04-12.41,P0.001);最后ACTH型垂体瘤患者较非ACTH患者术后更易发生一过性低钾血症(nonACTH-pituitary adenomas vs.ACTH-pituitary adenomas:OR=18.75,95%CI:6.55-53.66,P0.001)。(3)在探索影响垂体瘤患者术后发生一过性低钾血症的独立影响因素时,我们将单因素非条件Logistic回归分析中对垂体瘤患者术后发生一过性低钾血症有影响的所有因素包括患者的住院天数、籍贯、是否为ACTH型垂体腺瘤及是否伴有高血压等因素纳入多因素Logistic回归分析中,结果显示,功能型垂体腺瘤和ACTH型垂体腺瘤是患者术后发生一过性低钾血症的独立危险因素(non-ACTH-pituitary adenomas vs.ACTH-pituitary adenomas:OR=6.54,95%CI:1.76-24.33,P=0.005)。(4)为进一步验证垂体瘤致患者术后发生一过性低钾血症危险因素,我们详细探讨了22例垂体瘤患者发生术后低血钾患者的临床病理分型,其中ACTH垂体腺瘤10例(45.5%),另外12例发生术后一过性低钾的患者包括5例PRL垂体腺瘤、3例GH垂体腺瘤、2例无功能垂体腺瘤、1例FSH垂体腺瘤、1例TSH垂体腺瘤以及1例混合型垂体腺瘤。我们将样本分为ACTH垂体腺瘤组(ACTH组)和非ACTH垂体腺瘤(对照组),按重复测量资料方差分析原理探索影响垂体瘤患者术后发生一过性低钾的危险因素,结果显示,ACTH型垂体瘤患者术后容易发生一过性低钾具有统计学意义(P=0.005)。结论:垂体瘤分型为ACTH垂体腺瘤是术后发生一过性低钾的独立危险因素,临床工作中应着重监测ACTH垂体腺瘤患者术后血钾浓度变化,如果发生低血钾现象则立即体外补钾,最大程度的减少垂体瘤患者术后并发症,提高患者生活质量、减少患者住院时间。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.4

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