血清泌乳素水平对泌乳素瘤患者的临床价值研究
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摘要
目的:分析术前血清泌乳素水平对泌乳素瘤患者的临床价值。方法:选择2011年1月至2016年12月于青岛大学附属医院行垂体腺瘤切除术且术前测得泌乳素(prolactin,PRL)水平、术后行病理免疫组化染色的垂体腺瘤164例,通过Spearman相关分析PRL水平与肿瘤大小的相关性,通过Kappa值判断PRL水平与病理诊断的一致性。采用ROC曲线获得PRL水平最佳临床诊断临界值。结果:(1)164例垂体瘤患者中,病理诊断单激素PRL瘤25例,主要表现为男性性功能低下及头痛、头晕,女性月经紊乱、闭经、泌乳;(2)术前PRL水平与年龄、性别无显著相关性(P均>0.05),与肿瘤大小呈中度正相关(r=0.530,P<0.05);(3)以正常范围上限值(23.3 ng/m L)为基线,分别以PRL>23.3 ng/mL(1倍)、46.6 ng/m L(2倍)、69.9 ng/ml(3倍)、100 ng/mL、150 ng/m L、200 ng/mL为诊断标准,与病理免疫组化的一致性分析显示PRL>69.9ng/m L作为诊断标准时符合率和Kappa系数最高,分别为82.3%和0.533;(4)以病理免疫组化作为诊断金标准作泌乳素瘤ROC曲线,以血清PRL为69.785 ng/m L作为诊断标准时,曲线下面积最大,此时符合率和Kappa系数分别为82.3%和0.553,灵敏度49.1%,特异度98.3%。结论:泌乳素瘤血清学诊断与病理免疫组化诊断一致性较高,血清PRL水平>69.9 ng/mL(3倍于正常上限值)是诊断泌乳素瘤的最佳参考值。
Objective: To analyze the clinical value of preoperative serum prolactin level for the patients with prolactin tumor.Methods: 164 cases of pituitary adenomas undergoing pituitary adenoma resection in the Affiliated Hospital of Qingdao University from January 2011 to December 2016 were selected, the preprocedural prolactin(PRL) levels and postoperative pathological immunohistochemical staining were detected. The correlation of PRL level with tumor size was analyzed by Spearman correlation. The Kappa value was used to judge the consistency of PRL level and pathological diagnosis. The ROC curve was used to obtain the best clinical diagnosis threshold of PRL. Results:(1)Among the 164 patients with pituitary tumor, 25 cases of pathological diagnosis of single hormone PRL were mainly manifested as low male sexual function and headache, dizziness, menstrual disorder, amenorrhea and lactation.(2) There was no significant correlation between preoperative PRL level and age and gender(P>0.05), which was moderately positively correlated with tumor size(r=0.530, P<0.05).(3) The upper limit in the normal range(23.3 ng/m L) for the baseline, respectively by PRL> 23.3 ng/m L(1 times) and 46.6 ng/mL(2 times), 69.9 ng/mL(3 times), 100 ng/m L, 150 ng/m L, 200 ng/mL for diagnostic criteria, and pathological immunohistochemical analysis showed that the consistency and PRL>69.9 ng/mL as a diagnostic standard highest coincidence rate and Kappa coefficient, were 82.3% and 0.533 respectively.(4) With pathologic immunohistochemical as a diagnostic gold standard prolactin tumor ROC curve, when the serum PRL is 69.785 ng/ml as a diagnostic standard, the area under the curve is the largest, the coincidence rate and Kappa coefficient were 82.3%and 0.553 respectively, the sensitivity of 49.1%, the specific degree of 98.3%. Conclusions: The diagnosis and pathological immunohistochemical diagnosis of prolactin tumor were highly consistent, and the serum PRL level >69.9 ng/ml(3 times the normal upper limit) was the best reference value for the diagnosis of prolactin tumor.
Objective: To analyze the clinical value of preoperative serum prolactin level for the patients with prolactin tumor.Methods: 164 cases of pituitary adenomas undergoing pituitary adenoma resection in the Affiliated Hospital of Qingdao University from January 2011 to December 2016 were selected, the preprocedural prolactin(PRL) levels and postoperative pathological immunohistochemical staining were detected. The correlation of PRL level with tumor size was analyzed by Spearman correlation. The Kappa value was used to judge the consistency of PRL level and pathological diagnosis. The ROC curve was used to obtain the best clinical diagnosis threshold of PRL. Results:(1)Among the 164 patients with pituitary tumor, 25 cases of pathological diagnosis of single hormone PRL were mainly manifested as low male sexual function and headache, dizziness, menstrual disorder, amenorrhea and lactation.(2) There was no significant correlation between preoperative PRL level and age and gender(P>0.05), which was moderately positively correlated with tumor size(r=0.530, P<0.05).(3) The upper limit in the normal range(23.3 ng/m L) for the baseline, respectively by PRL> 23.3 ng/m L(1 times) and 46.6 ng/mL(2 times), 69.9 ng/mL(3 times), 100 ng/m L, 150 ng/m L, 200 ng/mL for diagnostic criteria, and pathological immunohistochemical analysis showed that the consistency and PRL>69.9 ng/mL as a diagnostic standard highest coincidence rate and Kappa coefficient, were 82.3% and 0.533 respectively.(4) With pathologic immunohistochemical as a diagnostic gold standard prolactin tumor ROC curve, when the serum PRL is 69.785 ng/ml as a diagnostic standard, the area under the curve is the largest, the coincidence rate and Kappa coefficient were 82.3%and 0.553 respectively, the sensitivity of 49.1%, the specific degree of 98.3%. Conclusions: The diagnosis and pathological immunohistochemical diagnosis of prolactin tumor were highly consistent, and the serum PRL level >69.9 ng/ml(3 times the normal upper limit) was the best reference value for the diagnosis of prolactin tumor.
引文
[1]杨阳.垂体泌乳素瘤早期诊断的临床研究[J].中国伤残医学, 2016,24(6):58-59
[2]罗文军,郭伟,罗甜,等.侵袭性垂体瘤的MRI诊断与影像学特征[J].现代肿瘤医学, 2014, 22(11):2724-2726
[3]张永超,张振,吴洪喜,等.垂体瘤质地与MR信号强度的相关性研究[J].中国实用神经疾病杂志, 2014, 17(19):24-25
[4]王博晨,刘卫平,魏礼洲,等.术前MRI影像对内镜下经鼻蝶垂体瘤切除术中垂体功能保护的价值[J].中国CT和MRI杂志, 2016, 14(3):18-20
[5] Gadelha MR, Trivellin G, Hernández Ramírez lC, et al. Geneticsof pituitary adenomas[J]. Front Horm Res, 2013, 41:111-140
[6] Booth A, Trudeau, Gomez C, et al. Persistent ERK/MAPK activation promotes lactotrope differentiation and diminishes tumor-igenic phenotype[J]. Mol Endocrinol, 2014, 28(12):1999-2011
[7]韦瑞红,伍丽群.垂体泌乳素瘤早期诊断的临床研究[J].中国妇幼保健, 2005, 20(21):2774-2775
[8] Casanueva FF, Molitch ME, Schlechte JA, et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas[J].Clin Endocrinol(Oxf), 2006, 65(2):265-273
[9] Raverrot G, Jouanneau E, Trouillas J. Management of Endocrine Disease:clinicopathological classification and molecular markers of pituitary tumours for personalized therapeutic strategies[J]. Eur J Endocrin,2014, 170(4):121-132
[10]李志辉,罗平. SPSS常用统计分析教程(第四版)[M].北京,电子工业出版社, 2015:93-99
[11]顾锋.重视下丘脑垂体疾病尤其是垂体瘤早期诊断和治疗策略[J].中国实用内科杂志, 2013, 33(7):493-496
[12]王本才,李静静,赵淑梅. 56例高泌乳素血症临床分析[J].临床医学, 2001, 21(3):26-27
[13]加娜尔·哈力克,艾比拜·玉素甫.泌乳素瘤54例临床分析[J].中国医师进修杂志, 2014, 37(9):45-47
[14] Li Chun-mei. The relationship between serum prolactin level and infertility[J]. Modern Chinese and Western Medicine Journal, 2008, 11(17):4905
[15] Wang Jia-ning. Pathogenesis and diagnosis and treatment of hyperprolactine[J]. Medical Review, 2012, 18(21):3630-3631
[16] NishiokaH, ItoH, HaraokaJ, et al. Growth potential off emale prolactinomas[J]. Surg Neurol, 2001, 55:213-217
[17] Day PF, loto MG, Glerean M et al. Incidence and prevalence of clinically relevant pituitary adenomas:retrospective cohort study in a Health Management Organization in Buenos Aires, Argentina[J].Arch Endocrinol Metab, 2016, 60:554
[18] Xie Yuan-run. Clinical analysis of 61 cases of prolactin tumor operation[D]. Kunming medical university, 2016
[19] Molitch ME. Diagnosisandtreatment of prolactinomas[J]. Adv Intern Me, 1999, 44:117-179
[20]朱梅,张勇,彭虹,等.血清PRL水平与MRI扫描垂体催乳素瘤的对比分析及临床应用[J].放射免疫学杂志, 2013, 26(2):135-137
[21] Bronstein MD. Disorders of prolactin secretion and prolactinomas[M]. In:De Groot lJ, Jameson Jl, editors. Endocrinology. 6th edition.Phladelphia:Saunders/Elsevier, 2016, 1:333-357
[22]邱爽,时立新,庄惠君. 428例垂体瘤患者临床特征分析[J].贵阳医学院学报, 2015, 40(11):1223-1225
[23] Zheng li-hong, Han Wen-qing, Jiang Ya-qiu. The clinicopathologic features and curative effect of high prolactin and pituitary adenoma in325 cases[J]. Chinese Journal of Practical Internal Medicine, 2017, 37(10):914-916
[24] Linsler S, Quack F, Schwerdtfeger K et al. Prognosis of pituitary adenomas in the early 1970s and today-Is there a benefit of modern surgical techniques and treatment modalities?[J]. Clin Neurol Neurosurg,2017, 156:4
[25]刘阳,连伟,王任直.垂体催乳素腺瘤诊疗中常见问题及解决方案[J].中国临床神经外科杂志, 2015, 20(11):698-700
[26]王任直,周良辅,周定标,等.中国垂体腺瘤外科治疗专家共识[J].中华医学杂志, 2015, 95(5):324-329
[27] Freda P, Katznelson l, Molitch M. The Hormone Foundation's Patient guide to pituitary incidentaloma assessment and treatment[J]. Clin Endocrinol Metab, 2011, 96(4):35A-36A
[28]赵雪兰,蒋翠萍,李益明. 2001例手术治疗垂体瘤患者临床分析[A].内分泌代谢性疾病系列研讨会暨中青年英文论坛, 2008
[29]彭蒙蒙,梁琳琅,邢雪.垂体瘤509例临床特点及术后长期随访分析[J].中国实用内科杂志, 2014, 34(5):488-491
[30] Felix I, Asa Sl, Kovacs K, et al. Recurrent phrihormonal birnorphous pituitary adenoma producing growth hormone, thyrotropin, and prolactin[J]. Arch Pathol lab, 1994, 118(1):66-70
[31] Glezer A, Bronstein MD. Prolactinomas, cabergoline, and pregnancy[J]. Endocrine, 2014, 47(1):64-69
[2]罗文军,郭伟,罗甜,等.侵袭性垂体瘤的MRI诊断与影像学特征[J].现代肿瘤医学, 2014, 22(11):2724-2726
[3]张永超,张振,吴洪喜,等.垂体瘤质地与MR信号强度的相关性研究[J].中国实用神经疾病杂志, 2014, 17(19):24-25
[4]王博晨,刘卫平,魏礼洲,等.术前MRI影像对内镜下经鼻蝶垂体瘤切除术中垂体功能保护的价值[J].中国CT和MRI杂志, 2016, 14(3):18-20
[5] Gadelha MR, Trivellin G, Hernández Ramírez lC, et al. Geneticsof pituitary adenomas[J]. Front Horm Res, 2013, 41:111-140
[6] Booth A, Trudeau, Gomez C, et al. Persistent ERK/MAPK activation promotes lactotrope differentiation and diminishes tumor-igenic phenotype[J]. Mol Endocrinol, 2014, 28(12):1999-2011
[7]韦瑞红,伍丽群.垂体泌乳素瘤早期诊断的临床研究[J].中国妇幼保健, 2005, 20(21):2774-2775
[8] Casanueva FF, Molitch ME, Schlechte JA, et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas[J].Clin Endocrinol(Oxf), 2006, 65(2):265-273
[9] Raverrot G, Jouanneau E, Trouillas J. Management of Endocrine Disease:clinicopathological classification and molecular markers of pituitary tumours for personalized therapeutic strategies[J]. Eur J Endocrin,2014, 170(4):121-132
[10]李志辉,罗平. SPSS常用统计分析教程(第四版)[M].北京,电子工业出版社, 2015:93-99
[11]顾锋.重视下丘脑垂体疾病尤其是垂体瘤早期诊断和治疗策略[J].中国实用内科杂志, 2013, 33(7):493-496
[12]王本才,李静静,赵淑梅. 56例高泌乳素血症临床分析[J].临床医学, 2001, 21(3):26-27
[13]加娜尔·哈力克,艾比拜·玉素甫.泌乳素瘤54例临床分析[J].中国医师进修杂志, 2014, 37(9):45-47
[14] Li Chun-mei. The relationship between serum prolactin level and infertility[J]. Modern Chinese and Western Medicine Journal, 2008, 11(17):4905
[15] Wang Jia-ning. Pathogenesis and diagnosis and treatment of hyperprolactine[J]. Medical Review, 2012, 18(21):3630-3631
[16] NishiokaH, ItoH, HaraokaJ, et al. Growth potential off emale prolactinomas[J]. Surg Neurol, 2001, 55:213-217
[17] Day PF, loto MG, Glerean M et al. Incidence and prevalence of clinically relevant pituitary adenomas:retrospective cohort study in a Health Management Organization in Buenos Aires, Argentina[J].Arch Endocrinol Metab, 2016, 60:554
[18] Xie Yuan-run. Clinical analysis of 61 cases of prolactin tumor operation[D]. Kunming medical university, 2016
[19] Molitch ME. Diagnosisandtreatment of prolactinomas[J]. Adv Intern Me, 1999, 44:117-179
[20]朱梅,张勇,彭虹,等.血清PRL水平与MRI扫描垂体催乳素瘤的对比分析及临床应用[J].放射免疫学杂志, 2013, 26(2):135-137
[21] Bronstein MD. Disorders of prolactin secretion and prolactinomas[M]. In:De Groot lJ, Jameson Jl, editors. Endocrinology. 6th edition.Phladelphia:Saunders/Elsevier, 2016, 1:333-357
[22]邱爽,时立新,庄惠君. 428例垂体瘤患者临床特征分析[J].贵阳医学院学报, 2015, 40(11):1223-1225
[23] Zheng li-hong, Han Wen-qing, Jiang Ya-qiu. The clinicopathologic features and curative effect of high prolactin and pituitary adenoma in325 cases[J]. Chinese Journal of Practical Internal Medicine, 2017, 37(10):914-916
[24] Linsler S, Quack F, Schwerdtfeger K et al. Prognosis of pituitary adenomas in the early 1970s and today-Is there a benefit of modern surgical techniques and treatment modalities?[J]. Clin Neurol Neurosurg,2017, 156:4
[25]刘阳,连伟,王任直.垂体催乳素腺瘤诊疗中常见问题及解决方案[J].中国临床神经外科杂志, 2015, 20(11):698-700
[26]王任直,周良辅,周定标,等.中国垂体腺瘤外科治疗专家共识[J].中华医学杂志, 2015, 95(5):324-329
[27] Freda P, Katznelson l, Molitch M. The Hormone Foundation's Patient guide to pituitary incidentaloma assessment and treatment[J]. Clin Endocrinol Metab, 2011, 96(4):35A-36A
[28]赵雪兰,蒋翠萍,李益明. 2001例手术治疗垂体瘤患者临床分析[A].内分泌代谢性疾病系列研讨会暨中青年英文论坛, 2008
[29]彭蒙蒙,梁琳琅,邢雪.垂体瘤509例临床特点及术后长期随访分析[J].中国实用内科杂志, 2014, 34(5):488-491
[30] Felix I, Asa Sl, Kovacs K, et al. Recurrent phrihormonal birnorphous pituitary adenoma producing growth hormone, thyrotropin, and prolactin[J]. Arch Pathol lab, 1994, 118(1):66-70
[31] Glezer A, Bronstein MD. Prolactinomas, cabergoline, and pregnancy[J]. Endocrine, 2014, 47(1):64-69