Clayton R N
Department of Medicine, School of Postgraduate Medicine, Keele University, Stroke on Trent, UK.
Growth Horm IGF Res. 1998 Feb;8 Suppl A:69-76. doi: 10.1016/s1096-6374(98)80013-0.
The issue of whether hypopituitarism is a risk factor for increased mortality from all causes, and particularly from vascular disease, has been evaluated in four retrospective analyses. In all studies, all-cause mortality was significantly increased by 1.3-2.2-fold compared to age- and sex-matched cohorts. The increase in vascular mortality was significant in the two studies from Sweden (1.8-1.9-fold) but not in the two from the UK (0.8-1.4-fold). The total number of deaths relating to all-cause and vascular mortality was relatively small, and the 95% confidence intervals on the observed to expected (O/E) mortality ratios were wide, in some instances crossing the unity line. As retrospective epidemiological studies, these trials suffer from several drawbacks. They included small numbers of patients and events (i.e. deaths), and determination of the number of deaths and their causes may be incomplete, with small additions or subtractions impacting on O/E mortality ratios. A precise diagnosis of pituitary hormone deficiency in patients recruited in the earlier years of the studies (pre-1965) often relied on historical details and not on firm biochemical values. None of the studies provided any measurement of growth hormone status for the cohorts, and in only one study was there any relationship between a particular axis deficiency and all-cause mortality. This finding suggested that hypogonadal subjects were relatively protected compared with eugonadal counterparts. However, this must be regarded as a preliminary conclusion. These retrospective studies indicate that there are no data to support a relationship between vascular or all-cause mortality in hypopituitarism and growth hormone deficiency. Nevertheless, they do provide preliminary evidence to suggest that it would be worthwhile to conduct a large, multicentre, prospective study of well-characterized and documented patients with a sufficient number of events, in order to establish definitively the relationship between various axis deficiencies and mortality.
垂体功能减退是否是全因死亡率增加，尤其是血管疾病导致死亡率增加的风险因素这一问题，已在四项回顾性分析中进行了评估。在所有研究中，与年龄和性别匹配的队列相比，全因死亡率显著增加了1.3至2.2倍。瑞典的两项研究中血管死亡率的增加具有显著性（1.8至1.9倍），但英国的两项研究中则不然（0.8至1.4倍）。与全因和血管死亡率相关的死亡总数相对较少，观察到的与预期（O/E）死亡率比值的95%置信区间较宽，在某些情况下跨越了统一线。作为回顾性流行病学研究，这些试验存在几个缺点。它们纳入的患者和事件（即死亡）数量较少，死亡数量及其原因的确定可能不完整，少量的增减就会影响O/E死亡率比值。在研究早期（1965年前）招募的患者中，垂体激素缺乏的精确诊断通常依赖于病史细节而非确切的生化值。没有一项研究对队列中的生长激素状态进行任何测量，只有一项研究探讨了特定轴系缺乏与全因死亡率之间的关系。这一发现表明，与性腺功能正常的受试者相比，性腺功能减退的受试者相对受到保护。然而，这必须被视为一个初步结论。这些回顾性研究表明，没有数据支持垂体功能减退患者的血管或全因死亡率与生长激素缺乏之间存在关联。尽管如此，它们确实提供了初步证据，表明进行一项针对特征明确且有充分记录、有足够数量事件的患者的大型多中心前瞻性研究，以明确确定各种轴系缺乏与死亡率之间的关系是值得的。
