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

Abstract

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

CLC Number:

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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References 32

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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

A study examining the association between hypopituitarism and metabolic-associated fatty liver disease following surgery for tumors in the sellar region among children

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