CAJ | 학술논문

目的分析不同放射剂量γ-刀治疗对功能性泌乳素(PRL)腺瘤的PRL水平的影响,判断PRL在γ-刀治疗功能性PRL腺瘤预后和指导激素替代治疗的作用.方法回顾性分析山东淄博万杰医院和广东深圳罗湖人民医院自2004年9月至2008年3月应用γ-刀治疗的248例功能性PRL腺瘤患者的临床资料,按治疗剂量将患者分组:Ⅰ组:50 Gy≤中心剂量<60 Gy;边缘剂量:20～30 Gy;Ⅱ组:40 Gy≤中心剂量<50 Gy;边缘剂量:15～25 Gy;Ⅲ组:30 Gy≤中心剂量<40Gy;边缘剂量12～20 Gy;术前、术后1月、3月、12月采用放射免疫法检测患者血清PRL水平,术后1年、2年复查头颅MRI观察肿瘤大小的变化.结果 3组患者术前PRL水平的差异有统计学意义(p<0.05),与Ⅰ、Ⅱ组比较,Ⅲ组PRL值偏低,术后12个月与Ⅰ组比较,Ⅲ组PRL值偏高;与术前相比,3组患者术后PRL水平均降低,差异有统计学意义(P<0.05);术后1年MRI显示肿瘤缩小198例(80%);术后2年肿瘤消失203例(82%),增大19例(7.7%),无变化26例(10.4%).结论不同剂量γ-刀治疗功能性PRL腺瘤对术后内分泌的恢复有很大的影响,中心剂量和边缘剂量(尤其是中心剂量)较高时,术后PRL易恢复正常.但远期是否会造成垂体低功需要长期随访.
목적 분석불동방사제량γ-도치료대공능성비유소(PRL)선류적PRL수평적영향,판단PRL재γ-도치료공능성PRL선류예후화지도격소체대치료적작용.방법 회고성분석산동치박만걸의원화엄동심수라호인민의원자2004년9월지2008년3월응용γ-도치료적248례공능성PRL선류환자적림상자료,안치료제량장환자분조:Ⅰ조:50 Gy≤중심제량<60 Gy;변연제량:20～30 Gy;Ⅱ조:40 Gy≤중심제량<50 Gy;변연제량:15～25 Gy;Ⅲ조:30 Gy≤중심제량<40Gy;변연제량12～20 Gy;술전、술후1월、3월、12월채용방사면역법검측환자혈청PRL수평,술후1년、2년복사두로MRI관찰종류대소적변화.결과 3조환자술전PRL수평적차이유통계학의의(p<0.05),여Ⅰ、Ⅱ조비교,Ⅲ조PRL치편저,술후12개월여Ⅰ조비교,Ⅲ조PRL치편고;여술전상비,3조환자술후PRL수평균강저,차이유통계학의의(P<0.05);술후1년MRI현시종류축소198례(80%);술후2년종류소실203례(82%),증대19례(7.7%),무변화26례(10.4%).결론 불동제량γ-도치료공능성PRL선류대술후내분비적회복유흔대적영향,중심제량화변연제량(우기시중심제량)교고시,술후PRL역회복정상.단원기시부회조성수체저공수요장기수방.
Objective To analyze the effects of-γ-knife treatment with different dosages on level of prolactin (PRL) in patients with different sizes of functional pituitary prolactinomas, and determine an index to guide hormone replacement therapy and the prognosis of -γ-knife treatment in patients with functional pituitary prolactinomas through comparing the changes of tumor sizes and the levels of PRL before and after -γ-knife treatment. Methods A retrospective analysis of the clinical data of 248 patients with functional pituitary prolactinomas was performed; gamma knife treatment was performed on these patients from September 2004 to March 2008. We divided the patients into 3 groups: group Ⅰ (50 Gy≤central dose<60 Gy, 20 Gy＜marginal dose<30 Gy), group Ⅱ (40 Gy≤ central dose＜50 Gy, 15 Gy＜marginal dose<25 Gy) and group Ⅲ (30 Gy ≤ central dose<40 Gy, 12 Gy＜marginal dose<20 Gy). The irradiation dose on optic nerves in the 3 groups was under 9 Gy. Radioimmunoassay was employed to detect the serum PRL level before and 1, 3 and 12 months after γ-knife treatment. The changes of the tumor sizes were observed and compared with cranial MRI 1 and 2 years after -γ-knife treatment.Results Significant differences on the PRL level were noted before -γ-knife treatment between each 2 groups (P<0.05); the PRL level in group Ⅲ was lower as compared with that in group Ⅰ and Ⅱ before γ-knife treatment; however, the PRL level in group Ⅲ was higher as compared with that in group 112 months after -γ-knife treatment; the PRL level in all the 3 groups after γ-knife treatment was significantly lower as compared with that before γ-knife treatment (P<0.05). MRI showed that the tumor had 80% partial response rate (198/248) in the 1st year, 82% complete response rate (203/248) in the 2nd year, increased volume in 19 patients (7.7%) and no change in 26 patients (10.4%). Conclusion Different treatment doses of Gamma knife on functional pituitary prolactinomas has great influences on postoperative recovery of endocrine; the higher doses of the center and edge (especially center), the higher normal rate of postoperative PRL level. Whether it will cause long-term hypopituitarism needs continue follow-up.