Investigation on relationship between pituitary denomaapoplexy and invasiveness of pituitary tumor based on propensity score matching method
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摘要:目的 应用倾向性得分匹配方法分析垂体腺瘤卒中出血与垂体腺瘤大小及侵袭性的关系。方法 回顾性分析570例垂体腺瘤患者的临床资料，按照垂体腺瘤是否发生卒中出血将患者分为卒中组100例与非卒中组470例。使用倾向性得分匹配方法控制基线资料干扰因素后，将卒中组与非卒中组以1：1比例进行匹配，应用条件Logistic分析对垂体腺瘤出血卒中与垂体腺瘤侵袭性的关系进行分析。结果 匹配前，2组性别、年龄及Knosp分级比较，差异有统计学意义（P < 0.05）。匹配后，平衡混杂因素，2组基线资料差异无统计学意义（P>0.05）。二元条件Logistic回归分析结果显示，垂体腺瘤卒中出血与垂体腺瘤的侵袭性显著相关（P=0.008），而与垂体腺瘤大小无相关性（P=0.746）。不同Knosp分级中，Knosp 3级是垂体腺瘤卒中的危险因素（P=0.019）。结论 侵袭性垂体腺瘤易发生卒中出血，肿瘤大小并不是影响垂体腺瘤卒中出血的因素，Knosp 3级的垂体腺瘤较其他级别更易发生卒中出血。对于伴有海绵窦侵犯的垂体腺瘤患者来说，无论肿瘤大小均应尽早接受治疗。Abstract:Objective To analyze the relationship between pituitary denoma apoplexy induced nemorrhage and invasiveness of pituitary tumor based on propensity score matching method.Methods The clinical data of 570 patients with pituitary adenoma was retrospectively analyzed, and the patients were divided into stroke group (100 cases) and non-stroke group (470 cases) according to occurrence of hemorrhage caused by stroke of pituitary adenoma. After eliminating the interfering factors of baseline data by the method of propensity score matching method, the stroke group and the non-stroke group were matched in a 1:1 ratio, and the relationship between hemorrhage caused by stroke and pituitary adenoma invasion was analyzed by conditional Logistic analysis.Results Before matching, there were statistically significant differences in gender, age and Knosp grading between the two groups (P < 0.05). After matching, after adjusting for confounding factors, there was no significant difference in baseline data between the two groups (P>0.05). The results of binary Logistic regression analysis showed that hemorrhage after pituitary adenoma stroke had significant correlation with the invasion of pituitary adenoma (P=0.008), but no correlation with the size of pituitary adenoma (P=0.746). Among different Knosp grading, Knosp grade 3 was a risk factor for pituitary adenoma stroke (P=0.019).Conclusion Pituitary tumors with invasion and those in Knosp 3 grading are more prone to present hemorrhage. The size of the pituitary tumor does not affect apoplexy. Therefore, pituitary tumor patients with cavernous sinus invasion should accept the treatment as early as possible regardless of the size of the tumor.
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Keywords:
- pituitary tumor /
- pituitary apoplexy /
- invasiveness /
- risk factors
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表 1 垂体腺瘤患者匹配前后一般资料比较(x±s)[n(%)]
一般资料 匹配前 匹配后 卒中组(n=100) 非卒中组(n=470) P 卒中组(n=100) 非卒中组(n=100) P 年龄/岁 53.90±12.27 50.82±12.60 0.026 53.90±12.27 53.54±11.68 0.832 性别 男 63(63.00) 228(48.51) 0.008 63(63.00) 59(59.00) 0.562 女 37(37.00) 242(51.49) 37(37.00) 41(41.00) 复发垂体腺瘤 是 6(6.00) 56(11.91) 0.085 6(6.00) 8(8.00) 0.579 否 94(94.00) 414(88.09) 94(94.00) 92(92.00) 肿瘤直径/cm 2.83±1.09 2.68±1.25 0.412 2.83±1.09 2.65±1.11 0.260 肿瘤分类 微腺瘤 1(1.00) 14(2.98) 0.258 1(1.00) 3(3.00) 0.143 大腺瘤 86(86.00) 407(86.60) 86(86.00) 85(85.00) 巨大腺瘤 13(13.00) 49(10.42) 13(13.00) 12(12.00) Knosp分级 0级 11(11.00) 80(17.02) < 0.001 11(11.00) 17(17.00) 0.029 1级 19(19.00) 156(33.19) 19(19.00) 30(30.00) 2级 14(14.00) 74(15.74) 14(14.00) 14(14.00) 3级 35(35.00) 67(14.26) 35(35.00) 21(21.00) 4级 21(21.00) 93(19.79) 21(21.00) 18(18.00) 高血压病 25(25.00) 121(25.74) 0.877 25(25.00) 23(23.00) 0.741 糖尿病 12(12.00) 41(8.72) 0.306 12(12.00) 13(13.00) 0.831 激素异常 泌乳素 46(46.00) 180(38.30) 0.153 46(46.00) 98(98.00) < 0.001 睾酮 17(17.00) 114(24.36) 0.686 17(17.00) 12(12.00) 0.315 生长激素 17(17.00) 88(17.82) 0.113 17(17.00) 31(31.00) 0.020 
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表 2 垂体腺瘤患者常见症状比较[n(%)]
症状 总体(n=570) 卒中组(n=100) 非卒中组(n=470) P 头痛 203(35.61) 56(56.00) 147(31.28) < 0.001 恶心 65(11.40) 23(23.00) 42(8.94) < 0.001 头晕 138(25.50) 31(31.00) 107(22.77) 0.081 眼肌麻痹 70(12.28) 31(31.00) 39(8.30) < 0.001 视物模糊 单侧 106(18.60) 23(23.00) 83(17.66) 0.007 双侧 243(42.63) 51(51.00) 192(40.85) 视野缺损 单侧 76(13.33) 21(21.00) 55(11.70) < 0.001 双侧 113(19.82) 32(32.00) 81(17.23) 意识障碍 17(2.98) 14(14.00) 3(0.64) < 0.001 面容改变 68(11.93) 6(6.00) 62(13.19) 0.044 月经紊乱 12(4.30) 2(5.41) 10(4.13) 0.722 溢乳 25(4.39) 4(4.00) 21(4.47) 0.836 月经紊乱发生率仅基于女性例数计算。
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表 3 垂体腺瘤卒中影响因素的条件Logistic回归分析
变量 调整前 调整后 OR 95%CI P OR 95%CI P 垂体腺瘤侵袭性 2.69 1.29~5.60 0.008 2.54 1.34~4.82 0.004 垂体腺瘤大小 0.95 0.69~1.30 0.746 - - - -为剔除变量，未纳入分析。
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