血清泌乳素水平对泌乳素瘤患者的临床价值研究

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,P0.05);(3)以正常范围上限值(23.3 ng/m L)为基线,分别以PRL23.3 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PRL69.9ng/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。

Clinical value of Preoperative prolactin level for the Prolactinoma Patients

ABSTRACT 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 immunohisto- chemical 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/mL) for the baseline, respectively by PRL> 23.3 ng/mL (1 times) and 46.6 ng/mL (2 times), 69.9 ng/mL (3 times), 100 ng/mL, 150 ng/mL, 200 ng/mL for diagnostic criteria, and pathological im- munohistochemical 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%. Conclusion: 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.