垂体强化MRI 对垂体柄阻断综合征的诊断价值 及对垂体－靶腺功能损伤的评估意义

Diagnostic value of pituitary enhanced MRI in pituitary stalk interruption syndrome and its correlation with pituitary-target gland dysfunction

摘要:

目的 分析垂体强化磁共振成像（MRI）在垂体柄阻断综合征中的诊断价值及对垂体- 靶腺功能 损伤的评估意义。方法 选取该院86 例垂体柄阻断综合征者为病例组，另选取50 例健康儿童和青少年为对照 组。根据病例组垂体MRI 表现，其中完全性垂体柄阻断者为A 组，部分性垂体柄阻断者为B 组。比较A 组、 B 组与对照组相关激素参数的水平，并分析MRI 表现与垂体- 靶腺功能损伤的关系。结果 病例组86 例患 者中垂体后叶正常4 例（4.65%），体积变小16 例（18.60%），发生异位56 例（65.12%），缺失10 例（11.63%）。 A 组、B 组睾酮（T）、雌二醇（E2）、促黄体生成素（LH）等性激素水平较对照组均降低（P <0.05），而A 组 T 水平较B 组降低（P <0.05），而A、B 两组其他性激素水平的比较，差异无统计学意义（P >0.05）。A 组皮质 醇（COR）、促肾上腺皮质激素（ACTH）、游离甲状腺素（FT4）、促甲状腺激素（TSH）等激素的水平较 对照组、B 组均降低（P <0.05）；B 组COR 和FT4 的水平较对照组均降低（P <0.05），而其他激素水平的比较， 差异无统计学意义（P >0.05）。A 组因垂体激素缺乏引起继发性肾上腺功能减退、甲状腺功能减退和中枢性 尿崩症的发生率较B 组升高（χ2=10.24、7.35 及9.35，均P <0.01）。结论 垂体强化MRI 能够有效诊断垂体 柄阻断综合征者垂体－靶腺功能损伤的状况，其在评估垂体柄阻断综合征垂体功能中具有较高的诊断价值。

Abstract:

Objective To analyze the diagnostic value of pituitary enhanced magnetic resonance imaging (MRI) in pituitary stalk interruption syndrome and its correlation with pituitary-target gland dysfunction. Methods A total of 86 cases of pituitary stalk interruption syndrome in our hospital were selected as the case group, and 50 healthy children and adolescents were selected as the control group. According to the pituitary MRI findings in the case group, the complete pituitary stalk block was collected as the group A, and the partial pituitary stalk blocking was collected as the group B. The levels of related hormones in group A, group B and control group were compared, and the relationship between MRI findings and pituitary-target gland function damage was analyzed. Results In the case group, there were 4 normal cases in the posterior pituitary (4.65%), 16 smaller volume cases (18.60%), 56 ectopic cases (65.12%), and 10 absent cases (11.63%). The testosterone (T), estradiol (E2), luteinizing hormone (LH) and other sex hormone levels in the group A and group B were significantly lower than those in the control group (all P< 0.05), and the T level of the group A decreased significantly in comparison to the group B (P < 0.05), and there were not statistically significant differences in comparison of other sex hormone levels (all P > 0.05). The cortisol (COR), adrenocorticotropic hormone (ACTH), free thyroxine (FT4), thyroid stimulating hormone (TSH) and other hormone levels in group A were lower than those in the control group and group B (all P < 0.05); the COR and FT4 levels in group B were significantly lower than those in the control group (both P < 0.05), and other hormone levels showed no significant differences (all P > 0.05). The incidence rate of secondary adrenal insufficiency, hypothyroidism and central diabetes insipidus in group A were significantly higher than those in the group B (χ2 = 10.24, 7.35, 9.35, all P < 0.01). Conclusion Enhanced MRI can effectively diagnose the pituitary-target gland function damage in patients with pituitary stalk interruption syndrome, and it is of higher diagnostic value in the evaluation of pituitary function, which is worthy of clinical promotion.