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目的分析育龄妇女高泌乳素血症(HPL)患者中垂体腺瘤(PA)等鞍区占位性病变的检出情况及影响因素,探讨鞍区核磁共振(MR)薄层动态增强扫描等检查对HPL患者病因诊断的作用及其意义。方法选择2011年1-12月在浙江省人民医院神经外科门诊和住院诊治的594例育龄期HPL患者作为研究对象,同时采用鞍区MR动态增强扫描检查和血清泌乳素(PRL)检测等进行PA等鞍区占位性病变的筛选和鉴别诊断。结果 594例HPL患者的首次血清PRL检测值为36~473 ng/ml,其中137例血清PRL检测值30~50 ng/ml,326例51~100 ng/ml,59例101~200 ng/ml,>200 ng/ml的72例。594例HPL患者中,92例确诊为PA,检出率为15.5%,甲状腺功能低下19例(3.2%),颅咽管瘤、空碟鞍等鞍区病变23例(3.9%),淋巴细胞性垂体炎13例(2.2%),药物性HPL 25例(4.2%),乳腺病42例(7.1%),卵巢囊肿、盆腔炎等妇科病49例(8.2%),特发性HPL患者331例(55.7%)。PA、药物性HPL和乳腺病患者血清PRL检测值大多在101~200 ng/ml。结论结合鞍区MR动态增强扫描和血清PRL动态检测可有效地进行鉴别诊断,可明确HPL的病因。针对HPL的病因治疗是迅速降低血清PRL值,恢复育龄期HPL患者正常月经周期和性腺生殖功能的关键。
Objective To analyze the detection and influential factors of space occupying lesion in pituitary adenoma (PA) in women of childbearing age with hyperprolactinemia (HPL) and to investigate the dynamic contrast-enhanced MRI The etiological diagnosis of HPL patients and its significance. Methods From January to December 2011, 594 probands of HPL in outpatient department and inpatient department of neurosurgery in Zhejiang Provincial People’s Hospital were enrolled in this study. Patients with PAH were studied by MR dynamic contrast-enhanced MRI and PRL detection Other saddle area occupying lesions screening and differential diagnosis. Results The first serum PRL of 594 HPL patients was 36 ~ 473 ng / ml, of which 137 were PRL 30 ~ 50 ng / ml, 326 51 ~ 100 ng / ml, 59 101 ~ 200 ng / ml ,> 200 ng / ml in 72 cases. Of 594 HPL patients, 92 were diagnosed as PA, with a detection rate of 15.5%, 19 cases of hypothyroidism (3.2%), 23 cases (3.9%) of craniofacial malignancies and saddle-zone lesions such as empty disk saddle, lymphocytes There were 13 cases of hypophysitis (2.2%), 25 cases of drug-induced HPL (4.2%), 42 cases of mastosis (7.1%), 49 cases of gynecological diseases such as ovarian cysts and pelvic inflammatory disease Cases (55.7%). PA, drug-induced HPL and breast disease patients with serum PRL most of the value of 101 ~ 200 ng / ml. Conclusions Combined with MR dynamic enhanced scan in sellar region and dynamic detection of serum PRL can effectively differentiate and diagnose the etiology of HPL. Etiological treatment for HPL is the key to rapidly reducing serum PRL and restoring the normal menstrual cycle and gonadal reproductive function in childbearing age patients with HPL.