Ayuk John, Stewart Susan E, Stewart Paul M, Sheppard Michael C
Division of Medical Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
J Clin Endocrinol Metab. 2002 Sep;87(9):4142-6. doi: 10.1210/jc.2001-011913.
Depot somatostatin analogs are now increasingly being prescribed as adjuvant and primary therapy for the treatment of acromegaly. Previous studies have shown them to be both effective and safe, suppressing GH levels to less than 2 micro g/liter in 50-65% of cases and normalizing serum IGF-I levels in 65%. However, published data on their long-term efficacy and safety is scanty. We analyzed data from 22 patients (16 female and 6 male) treated with Sandostatin LAR or Lanreotide for an average of 41 months (range 12-89). Three patients had previously been treated with surgery, two with radiotherapy, and seven with both. Ten patients had received primary medical therapy. Mean pretreatment GH levels were 13.1 +/- 3.4 micro g/liter, and IGF-I levels were 592.9 +/- 53.9 micro g/liter. Results after 12 months of therapy indicated reduction in GH (3.2 +/- 0.7 micro g/liter; P < 0.0001) and IGF-I (321.9 +/- 33.9 micro g/liter; P < 0.001) concentrations, and this was sustained at latest follow-up. Using GH criteria (serum GH < 2 micro g/liter), 46% of subjects achieved a cure at 12 months, and 36% achieved a cure long-term. Fifty-two percent achieved normal IGF-I values at 12 months, and 67% long-term. Mean fasting and 2-h plasma glucose concentrations were similar at latest follow-up and at 12 months to baseline values. Three patients developed impaired glucose tolerance within 12 months of treatment, one going on to develop frank diabetes mellitus. However, glucose tolerance improved in five patients. Five patients developed gallstones while on treatment. In summary, this study reports the long-term efficacy of the depot somatostatin analogs as either adjuvant or primary therapy. Although overall glucose tolerance did not change, the development of impaired glucose tolerance in three patients at a time when GH levels were not changing highlights the ongoing need to monitor the long-term safety of these preparations.
长效生长抑素类似物目前越来越多地被用作肢端肥大症治疗的辅助和主要疗法。先前的研究表明它们既有效又安全，在50%-65%的病例中将生长激素水平抑制至低于2微克/升，65%的病例中使血清胰岛素样生长因子-I（IGF-I）水平恢复正常。然而，关于其长期疗效和安全性的已发表数据很少。我们分析了22例患者（16例女性和6例男性）的数据，这些患者接受善龙（Sandostatin LAR）或兰瑞肽治疗，平均治疗时间为41个月（范围12-89个月）。3例患者先前接受过手术治疗，2例接受过放射治疗，7例两者都接受过。10例患者接受过初始药物治疗。治疗前生长激素平均水平为13.1±3.4微克/升，IGF-I水平为592.9±53.9微克/升。治疗12个月后的结果显示生长激素（3.2±0.7微克/升；P<0.0001）和IGF-I（321.9±33.9微克/升；P<0.001）浓度降低，且在最近一次随访时仍持续。根据生长激素标准（血清生长激素<2微克/升），46%的受试者在12个月时达到治愈，36%长期治愈。52%的受试者在12个月时IGF-I值恢复正常，67%长期恢复正常。最近一次随访时的平均空腹和2小时血浆葡萄糖浓度与12个月时及基线值相似。3例患者在治疗12个月内出现糖耐量受损，其中1例进而发展为显性糖尿病。然而，5例患者的糖耐量有所改善。5例患者在治疗期间出现胆结石。总之，本研究报告了长效生长抑素类似物作为辅助或主要疗法的长期疗效。尽管总体糖耐量没有变化，但在生长激素水平未改变时3例患者出现糖耐量受损突出表明仍需要持续监测这些制剂的长期安全性。
