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目的探讨影响垂体泌乳素瘤生物学行为的因素。方法123例垂体泌乳素腺瘤患者,其中男40例,女83例。将123例患者的肿瘤组织镜下标本经10%福尔马林或70%乙醇固定,进行常规病理及免疫组化分析。测定123例患者肿瘤切除前后的血清泌乳素水平。对26例女性患者肿瘤组织标本提取的DNA进行了HUMARA分析,确定肿瘤的克隆状态。结果123例患者中单激素分泌性61例(50%),多激素分泌性62例(50%)。患者年龄大小与血清泌乳素水平呈正相关(ρ=0.337,P<0.01),患者年龄与肿瘤体积呈正相关(ρ=0.378,P<0.01),肿瘤体积与血清泌乳素水平呈正相关(ρ=0.670,P<0.01)。多元回归分析提示,只有肿瘤体积与血清泌乳素水平存在明显相关。Mann-WhitneyU检验提示,泌乳素水平越高肿瘤体积越大,患者年龄越大,肿瘤侵袭海绵窦越明显。男性患者血清泌乳素水平明显高于女性患者,同时肿瘤体积明显较大。11例患者多激素分泌性垂体泌乳素腺瘤为单克隆起源。结论垂体泌乳素腺瘤患者除了分泌泌乳素外,还可以分泌多种垂体激素,而且绝大多数多激素分泌性垂体腺瘤的起源是单克隆性的。
Objective To explore the factors affecting the biological behavior of pituitary prolactinoma. Methods 123 cases of pituitary prolactinoma patients, including 40 males and 83 females. 123 cases of tumor tissue microscopy specimens were fixed by 10% formalin or 70% ethanol for routine pathological and immunohistochemical analysis. Serum prolactin levels were measured in 123 patients before and after tumor resection. HUMARA analysis was performed on DNA extracted from tumor samples of 26 female patients to determine the clonal status of the tumors. Results In 123 patients, the secretion of mononuclear hormones was 61 (50%) and the secretion of hyperogesis was 62 (50%). There was a positive correlation between age and serum prolactin level (ρ = 0.337, P <0.01). There was a positive correlation between age and tumor volume (ρ = 0.378, P <0.01), and tumor volume was positively correlated with serum prolactin level , P <0.01). Multivariate regression analysis showed that only tumor volume and serum prolactin levels were significantly correlated. Mann-WhitneyU test showed that the higher the level of prolactin, the larger the tumor volume, the older the patient, the more obvious tumor invasion of the cavernous sinus. Male patients with serum prolactin levels were significantly higher than female patients, while the tumor volume was significantly larger. Eleven patients had multiple hormonal secretions of pituitary prolactinomas as monoclonal origin. Conclusion Pituitary prolactinoma patients in addition to secretion of prolactin, but also can secrete a variety of pituitary hormones, and most of the origin of multi-hormone secreting pituitary adenoma is monoclonal.