动脉瘤性蛛网膜下腔出血术后垂体功能减退的临床研究

A clinical study of hypopituitarism after surgery for aneurysmal subarachnoid hemorrhage

摘要:

目的 探讨动脉瘤性蛛网膜下腔出血（aSAH）患者术后垂体功能减退情况及其对预后的影响。方法 分析2015年1月—2020年12月在宜春市人民医院治疗的aSAH患者82例。通过检测患者术后血清垂体激素、甲状腺激素、皮质醇、胰岛素样生长因子、睾酮和雌二醇，评估其术后垂体功能减退的发生率。采用多因素Logistic回归分析垂体功能减退的影响因素。应用格拉斯哥预后评分（GOS）随访评估患者3个月预后，分析垂体功能减退对患者预后的影响。结果 aSAH患者术后垂体功能减退总体发生率为65.9%（54/82），垂体性腺轴功能减退发生率最高为51.2%。多因素分析显示Hunt-Hess 3级(OR=4.873，P=0.034)和手术夹闭(OR=4.561，P=0.008)是垂体功能减退的危险因素。垂体功能减退并不影响患者3个月预后（P＞0.05），在单因素分析中显示垂体肾上腺轴功能减退患者，不良预后发生率为47.1%，高于垂体功能正常患者（P＜0.05），将年龄、Hunt-Hess分级、动脉瘤部位和手术方式纳入多因素分析时，垂体肾上腺轴功能减退与患者不良预后并不相关(OR=3.218，P=0.322)。结论 aSAH患者手术干预后垂体功能减退发生率高，Hunt-Hess 3级和手术夹闭是垂体功能减退的危险因素，但术后垂体功能减退并不影响患者3个月预后。

Abstract:

Objective To investigate the condition of hypopituitarism in patients after surgery for aneurysmal subarachnoid hemorrhage and its influence on prognosis.Methods A retrospective analysis was performed for 82 patients with aneurysmal subarachnoid hemorrhage who were treated in Yichun People’s Hospital from January 2015 to December 2020. The incidence rate of postoperative hypopituitarism was assessed by measuring the serum levels of pituitary hormone， thyroid hormone， cortisol， insulin-like growth factor， testosterone， and estradiol after surgery. A logistic regression analysis was used to investigate the influencing factors for hypopituitarism. Glasgow Outcome Scale （GOS） was used to evaluate the 3-month prognosis of patients， and the influence of hypopituitarism on prognosis was analyzed.Results The overall incidence rate of postoperative hypopituitarism was 65.9% （54/82） in the patients with aneurysmal subarachnoid hemorrhage， and hypopituitarism of the pituitary-gonad axis had the highest incidence rate of 51.2%. The multivariate analysis showed that Hunt-Hess grade 3 （OR=4.873，P=0.034） and surgical clipping （OR=4.561，P=0.008） were risk factors for hypopituitarism. Hypopituitarism did not affect the 3-month prognosis of patients （P >0.05）， and the univariate analysis showed that the incidence rate of adverse prognosis was 47.1% in the patients with hypopituitarism of the pituitary-gonad axis， which was significantly higher than that in the patients with normal pituitary function （P <0.05）， and when age， Hunt-Hess grade， location of aneurysm， and surgical procedure were included in the multivariate analysis， hypopituitarism of the pituitary-gonad axis was not associated with the prognosis of patients （OR=3.218，P=0.322）.Conclusions There is a high incidence rate of hypopituitarism in patients after surgery for aneurysmal subarachnoid hemorrhage， and Hunt-Hess grade 3 and surgical clipping are risk factors for hypopituitarism， while hypopituitarism after surgery does not affect the 3-month prognosis of patients.