目的:越来越多的证据表明,库欣病(CD)患者的多系统发病率在治疗后仅部分可逆。我们调查了与垂体手术后无功能垂体腺瘤(NFPA)患者相比,住院CD患者的多器官并发症。
方法:使用2012年1月至2021年12月瑞士联邦统计局的数据进行基于人群的回顾性队列研究。
方法:通过1:5的倾向得分匹配,我们比较了接受垂体手术的住院患者的CD或NFPA,解决人口差异。主要复合终点包括全因死亡率,主要不良心脏事件(即心肌梗塞,不稳定型心绞痛,心力衰竭,心脏骤停,缺血性卒中),因精神疾病住院,脓毒症,严重血栓栓塞事件,骨折需要住院治疗.次要终点包括主要终点和由于疾病持续或复发而导致的手术再干预的单个组成部分。
结果:匹配后,116例CD患者(平均年龄45.4岁[SD,14.4],75.0%女性)和396名NFPA(47.3岁[14.3],69.7%的女性)被包括在内,并在垂体手术后的中位时间为50.0个月(IQR23.5,82.0)。CD的存在与主要终点的较高发生率相关(40.6vs.每1000人年15.7次事件,HR2.75;95%CI,1.54至4.90)。CD患者的精神疾病住院率也增加(HR3.27;95%CI,1.59至6.71),败血症有趋势(HR3.15;95%CI,0.95至10.40)。
结论:即使在垂体手术后,CD患者面临更高的并发症风险,尤其是精神病住院和败血症.
OBJECTIVE: There is increasing evidence that multisystem morbidity in patients with Cushing\'s disease (CD) is only partially reversible following treatment. We investigated complications from multiple organs in hospitalized patients with CD compared to patients with non-functioning pituitary adenoma (NFPA) after pituitary surgery.
METHODS: Population-based retrospective cohort
study using data from the Swiss Federal Statistical Office between January 2012 and December 2021.
METHODS: Through 1:5 propensity score matching, we compared hospitalized patients undergoing pituitary surgery for CD or NFPA, addressing demographic differences. The primary composite endpoint included all-cause mortality, major adverse cardiac events (i.e., myocardial infarction, unstable angina, heart failure, cardiac arrest, ischemic stroke), hospitalization for psychiatric disorders, sepsis, severe thromboembolic events, and fractures in need of hospitalization. Secondary endpoints comprised individual components of the primary endpoint and surgical reintervention due to disease persistence or recurrence.
RESULTS: After matching, 116 patients with CD (mean age 45.4 years [SD, 14.4], 75.0% female) and 396 with NFPA (47.3 years [14.3], 69.7% female) were included and followed for a median time of 50.0 months (IQR 23.5, 82.0) after pituitary surgery. CD presence was associated with a higher incidence rate of the primary endpoint (40.6 vs. 15.7 events per 1,000 person-years, HR 2.75; 95% CI, 1.54 to 4.90). CD patients also showed increased hospitalization rates for psychiatric disorders (HR 3.27; 95% CI, 1.59 to 6.71) and a trend for sepsis (HR 3.15; 95% CI, 0.95 to 10.40).
CONCLUSIONS: Even after pituitary surgery, CD patients faced a higher hazard of complications, especially psychiatric hospitalizations and sepsis.