育齡期女性垂體催乳素腺瘤手術(shù)療效及預(yù)后預(yù)測(cè)模型研究

關(guān)鍵詞】育齡期女性；垂體催乳素腺瘤；經(jīng)蝶手術(shù)；生化緩解；列線圖 【中圖分類(lèi)號(hào)】 R651.1⁺3 【文獻(xiàn)標(biāo)志碼】 A 【文章編號(hào)】1672-7770（2025）03-0291-07

Abstract：ObjectiveTo study the influencing factors of biochemical remission after neuroendoscopic transsphenoidal resection of prolactin adenoma in female patientsof reproductive age and to construct a relevant prediction model. MethodsThe clinical data of 232 patients underwent transsphenoidal prolactin adenoma resection in the Department of Neurosurgery，the Affiliated Hospital of Xuzhou Medical University from January 2O15 to May 2O23 were retrospectively analyzed，and they were randomly divided into a training group and a validation group according to the ratio of 7：3. Independent risk factors affecting biochemical remission after surgery were screened using unifactorial and multifactorial analyses and included in the prediction model. ResultsThe patients’ body mass index（BMI），preoperative Knosp classification of pituitary tumors， postoperative prolactinvalue on the first day，and Ki-67 were the independent risk factorsaffecting the patients' postoperative biochemical remisson. The area under the ROC curve of the prediction model built in this way was O.85 and O.94 in the training and validation sets，respectively，and was wellcalibrated and clinically useful. ConclusionsIn this study，a prediction model affecting biochemical remission after neuroendoscopic transsphenoidal prolactin adenoma resection was constructed by multifactorial analysis，which has good clinical utility and can provide clinical reference value for the selection of treatment options for female prolactin adenoma patients in reproductive age.

Key words：female of childbearingage；prolactinadenoma；transepithelial surgery; biochemical remission ； columnar line drawing

垂體腺瘤（pituitaryadenoma，PA）是臨床常見(jiàn)的顱內(nèi)原發(fā)性腫瘤，其在顱內(nèi)腫瘤的發(fā)病率約為15% ，僅次于神經(jīng)上皮源性腫瘤和腦膜瘤[1]。其中垂體催乳素腺瘤發(fā)病率最高，約占所有功能性垂體腺瘤的 51%～66%^[2] 。統(tǒng)計(jì)資料顯示，育齡期女性是最常見(jiàn)的受影響人群[3]。目前，經(jīng)鼻神經(jīng)內(nèi)鏡下經(jīng)蝶垂體腺瘤切除術(shù)（transsphenoidalsurgery，TSS）仍是針對(duì)該病最有效的治療手段之一[4]。雖然口服多巴胺受體激動(dòng)劑對(duì)部分患者有降低催乳素（prolactin，PRL），控制腫瘤生長(zhǎng)的作用，但長(zhǎng)期服藥的依從性、藥物不良反應(yīng)等問(wèn)題仍然困擾很多該類(lèi)患者[4]。關(guān)于育齡期女性手術(shù)療效分析及預(yù)后預(yù)測(cè)模型的研究較少，本研究收集神經(jīng)外科2015年1月—2023年5月收治的232例育齡期女性垂體催乳素腺瘤患者，旨在探討影響生化緩解的因素，并構(gòu)建預(yù)測(cè)模型。現(xiàn)報(bào)告如下。

1資料與方法

1.1一般資料共納入神經(jīng)內(nèi)鏡經(jīng)蝶手術(shù)治療的232例育齡期女性垂體催乳素腺瘤患者，其中年齡15～55 歲，平均年齡36歲；首診臨床癥狀為視物重影或視物模糊者64例（ 27.2% ）（經(jīng)術(shù)前眼科檢查視力 lt;1.0 ），頭暈、頭痛者99例（ 42.1% ），月經(jīng)周期改變者56例 （23.8% ）（月經(jīng)周期改變包括術(shù)前停經(jīng)、術(shù)前經(jīng)期周期延長(zhǎng)、術(shù)前經(jīng)期周期縮短），溢乳者31例 （13.1% ）（排除哺乳期女性，術(shù)前出現(xiàn)乳水分泌）；無(wú)明顯臨床表現(xiàn)，經(jīng)體檢檢查出患者43例（ 18.5% ）。納入標(biāo)準(zhǔn)：（1）術(shù)前PRL檢測(cè)及病理結(jié)果確診為垂體催乳素腺瘤；（2）首次行TSS；（3）育齡期女性患者。排除標(biāo)準(zhǔn)：（1）既往垂體腺瘤手術(shù)史或放療史；……