儿童鞍区肿瘤术后垂体功能减退与代谢相关脂肪性肝病关系的研究

doi:10.12372/jcp.2025.24e0929

摘要/Abstract

摘要：

目的探讨儿童鞍区肿瘤术后垂体功能减退与代谢相关脂肪性肝病（MAFLD）的临床关系。方法选取2017年1月至2023年12月规律随访1年以上的鞍区肿瘤术后垂体功能减退患儿。通过肝脏超声检查，将患儿分为MAFLD（+）组和MAFLD（-）组，对比两组的临床和生化参数。结果共纳入33例患儿，其中MAFLD（+）组16例（48.5%），MAFLD（-）组17例（51.5%）。两组间年龄和性别无显著差异。所有33例患儿均患有生长激素缺乏症（GHD）和中枢性甲减（CH）。30例（91%）患儿有肾上腺皮质功能不全（AI），两组间分布均衡。22例（66.7%）患儿有中枢性尿崩症（CDI），其中MAFLD（+）组8例（36.4%），MAFLD（-）组14例（63.6%）。7例（21.2%）患儿表现出渴感减退性高钠血症，全部在MAFLD（+）组。所有患儿均接受左甲状腺素钠片替代治疗，30例AI患儿均接受生理剂量氢化可的松片替代治疗。MAFLD（+）组的身高SDS及BMI均高于MAFLD（-）组（P<0.001）。此外，MAFLD（+）组的空腹血糖、胰岛素、HOMA-IR、ALT、γ-GT、UA、PRL、TG水平显著高于MAFLD（-）组，而HDL-C水平则明显低于后者（P<0.05）。两组间在IGF-1 SDS、FT₃、FT₄、T₃、T₄、TSH、TBil、AST、Alb、TC、LDL-C等参数上有显著差异。13例患儿接受重组人生长激素（rhGH）治疗后，他们的TG、LDL-C水平明显下降，差异有统计学意义（P<0.05）。结论鞍区肿瘤术后垂体功能减退的患儿中，MAFLD的发生率较高。下丘脑功能受损的患者，特别是那些出现下丘脑性肥胖、渴感减退性高钠血症和泌乳素升高的患儿，更易罹患MAFLD。rhGH治疗对此类患儿代谢指标的影响尚需进一步研究。

关键词: 垂体功能减退, 代谢相关脂肪性肝病, 重组人生长激素, 儿童

Abstract:

Objective To investigate the clinical relationship between hypopituitarism and metabolic-associated fatty liver disease (MAFLD) in children with sellar region tumor after surgery. Methods From January 2017 to December 2023, patients with hypopituitarism resulting from sellar tumors were consistently monitored for over a year. All patients were categorized into either the MAFLD (+) group or the MAFLD (-) group based on liver ultrasonography. A comparison was then made between the clinical and biochemical parameters of the two groups. Results A total of 33 patients were included, with 16 patients (48.5%) in the MAFLD (+) group and 17 patients (51.5%) in the MAFLD (-) group. There were no significant differences in age or gender between the two groups. All patients had GHD (100%) and CH (100%). AI was present in 30 patients (91%), with equal distribution between the MAFLD (+) and (-) groups (50% each). CDI was diagnosed in 22 patients (66.7%), with more patients in the MAFLD (-) group (63.6%) compared to the MAFLD (+) group (36.4%). Hypernatremia hypodipsia occurred in 7 patients (21.2%), all belonging to the MAFLD (+) group. All CH patients were treated with oral levothyroxine sodium tablets, while 30 AI patients received oral hydrocortisone tablets. The height SDS and BMI were significantly higher in the MAFLD (+) group compared to the MAFLD (-) group (P<0.001). Fasting blood glucose, insulin, HOMA-IR, ALT, γ-GT, UA, PRL, and TG levels were significantly elevated in the MAFLD (+) group compared to the MAFLD (-) group, while HDL-C levels were significantly lower (P<0.05). No significant differences were observed in IGF-1 SDS, FT₃, FT₄, T₃, T₄, TSH, TBil, AST, Alb, TC, and LDL-C between the two groups. After treatment with recombinant human growth hormone (rhGH), there was a statistically significant decrease in TG and LDL-C levels among the patients. Conclusion After surgery for sellar region tumors, patients with hypopituitarism often experience a high incidence of MAFLD and hypothalamic dysfunction. This dysfunction can manifest as hypothalamic obesity, hypernatremia, and elevated prolactin levels, all of which increase the risk of developing MAFLD. Furthermore, treatment with rhGH may help improve metabolic markers among these patients.

Key words: hypopituitarism, metabolic-associated fatty liver disease, recombinant human growth hormone, child

中图分类号:

杜婷婷, 姚辉, 陈晓红, 杨禄红, 丰利芳, 陈晓倩, 胡曼, 李亚坤. 儿童鞍区肿瘤术后垂体功能减退与代谢相关脂肪性肝病关系的研究[J]. 临床儿科杂志, 2025, 43(6): 438-444.

DU Tingting, YAO Hui, CHEN Xiaohong, YANG Luhong, FENG Lifang, CHEN Xiaoqian, HU Man, LI Yakun. A study examining the association between hypopituitarism and metabolic-associated fatty liver disease following surgery for tumors in the sellar region among children[J]. Journal of Clinical Pediatrics, 2025, 43(6): 438-444.

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项目	MAFLD(+)组（n=16）	MAFLD(-)组（n=17）	统计量	P
年龄($\bar{x}±s$)/岁	10.1±2.4	9.0±4.3	t=0.94	0.361
性别（男）[n(%)]	10(62.5)	7(41.2)	χ²=1.50	0.303
随访时间[M(P₂₅~P₇₅)]/a	2.4（1~4.9）	2.8（1~11）	Z=1.91	0.085
手术时BMI($\bar{x}±s$)/kg·m^-2	17.9±4.4	16.3±2.0	t=1.17	0.254
身高SDS($\bar{x}±s$)	-1.3±1	-3±1.1	t=4.61	<0.001
BMI($\bar{x}±s$)/kg·m^-2	24.3±3.2	17.6±2	t=7.16	<0.001
GHD[n(%)]	16(100)	17(100)	-	-
甲状腺功能减退[n(%)]	16(100)	17(100)	-	-
优甲乐剂量($\bar{x}±s$)/μg	50.8±9.6	37±12.6	t=3.49	0.002
肾上腺皮质功能减退[n(%)]	15(93.8)	16(94.1)	χ²=0.00	1.000
氢化可的松剂量($\bar{x}±s$)/mg	8.1±3.8	8.2±3.9	t=1.98	0.845
中枢性尿崩症[n(%)]	8(50.0)	14(82.4)	χ²=3.88	0.071
渴感减退性高钠血症[n(%)]	7(43.8)	0(0)	χ²=9.44	0.003

项目	MAFLD(+)组（n=16）	MAFLD(-)组（n=17）	统计量	P
IGF-1 SDS($\bar{x}±s$)	-2.7±0.6	-2.8±0.6	t=0.06	0.58
GLU($\bar{x}±s$)/mmol·L^-1	4.74±0.4	4.24±0.4	t=3.40	0.002
INS[M(P₂₅~P₇₅)]/μIU·mL^-1	20.1（16.7~26.4）	4.7（2.92~7.92）	Z=4.86	<0.001
HOMA-IR[M(P₂₅~P₇₅)]	4.0（3.6~5.4）	0.9（0.5~1.5）	Z=4.79	<0.001
UA($\bar{x}±s$)/μmol·L^-1	469±120	299±92	t=4.56	<0.001
FT₃($\bar{x}±s$)/pmol·L^-1	5.0±0.9	4.9±1.1	t=0.32	0.753
FT₄($\bar{x}±s$)/pmol·L^-1	13.6±3.7	15.3±3.3	t=1.40	0.173
TSH[M(P₂₅~P₇₅)]/μIU·mL^-1	0.07（0.2~1.4）	0.02（0.01~0.4）	Z=0.33	0.326
TBil[M(P₂₅~P₇₅)]/μmol·L^-1	7.4（3.8~10.6）	6.6（5.8~10.4）	Z=0.07	0.958
Alb[M(P₂₅~P₇₅)]/g·L^-1	45.5（42.6~47.2）	45.1（43.9~49.2）	Z=0.54	0.102
ALT[M(P₂₅~P₇₅)]/IU·L^-1	22.0（14~53）	13．0（9~15）	Z=3.45	<0.001
AST[M(P₂₅~P₇₅)]/IU·L^-1	34.0（21~41）	26.0（22~33）	Z=1.43	0.157
γ-GT[M(P₂₅~P₇₅)]/IU·L^-1	27.0（16~41）	11.0（9~13）	Z=3.34	<0.001
TC($\bar{x}±s$)/mmol·L^-1	5.6±1.7	4.8±1.1	t=1.55	0.126
TG[M(P₂₅~P₇₅)]/mmol·L^-1	2.7（1.6~4.4）	0.9（0.7~1.6）	Z=3.82	<0.001
LDL-C($\bar{x}±s$)/mmol·L^-1	3.7±1.5	3.2±1.8	t=1.08	0.287
HDL-C($\bar{x}±s$)/mmol·L^-1	0.86±0.2	1.33±0.3	t=5.67	<0.001
PRL[M(P₂₅~P₇₅)]/μIU·mL^-1	360.8（209.5~502.0）	89.6（15.1~187.2）	Z=3.67	<0.001

项目	rhGH治疗组				未予rhGH治疗组
项目	基线	治疗后	统计量	P	基线	随访后	统计量	P
身高SDS($\bar{x}±s$)	-2.4±1.4	-1.1±1.0	t=2.75	0.011	-1.8±1.8	-2.2±1.4	t=0.74	0.465
BMI($\bar{x}±s$)/kg·m^-2	20.8±4.2	19.1±3.7	t=1.03	0.312	20.9±4.5	22.2±3.9	t=0.97	0.338
GLU($\bar{x}±s$)/mmol·L^-1	4.4±0.4	4.2±0.5	t=1.48	0.153	4.5±0.5	4.3±0.4	t=1.55	0.130
INS[M(P₂₅~P₇₅)]/μIU·mL^-1	10.5（3.7~20.3）	6.2（3.8~14.9）	Z=0.69	0.511	14.5（9.7~21.2)	16.6（4.8~22.3）	Z=0.41	0.698
HOMA-IR[M(P₂₅~P₇₅)]	2.0（0.7~4.2）	1.3（0.7~2.7）	Z=0.95	0.362	3.5（0.9~4.4）	2.7（1.6~4.1）	Z=0.16	0.883
TC($\bar{x}±s$)/mmol·L^-1	5.3±0.9	4.4±0.7	t=2.64	0.014	5.0±1.7	5.0±1.3	t=0.0	0.998
TG($\bar{x}±s$)/mmol·L^-1	1.8±0.8	1.3±0.5	t=1.96	0.062	2.4±1.7	2.2±1.4	t=0.32	0.751
LDL-C($\bar{x}±s$)/mmol·L^-1	3.8±0.9	2.8±0.6	t=3.49	0.002	3.3±1.6	3.4±1.3	t=0.35	0.725
HDL-C($\bar{x}±s$)/mmol·L^-1	1.2±0.4	1.2±0.2	t=0.52	0.607	1.1±0.3	1.2±0.8	t=0.66	0.511
ALT[M(P₂₅~P₇₅)]/IU·L^-1	14（12~34.5）	11（8.5~18）	Z=1.52	0.139	16（11.3~27.3）	14（11~27.8）	Z=0.30	0.779
AST[M(P₂₅~P₇₅)]/IU·L^-1	30（22~34.5）	25（18.5~27）	Z=1.75	0.081	26.5（21.2~34）	23.5（19.3~41.5）	Z=0.61	0.547