Holdaway I M, Rajasoorya C R, Gamble G D, Stewart A W
Department of Endocrinology, Auckland Hospital, Park Road, Auckland 1, New Zealand.
Growth Horm IGF Res. 2003 Aug;13(4):185-92. doi: 10.1016/s1096-6374(03)00030-3.
A number of groups have developed guidelines to indicate whether an individual with acromegaly has been cured by treatment. However, studies to date do not provide a robust definition of biochemical remission of the disorder based on correlation with long-term outcome. Available data suggest that those with a random serum growth hormone (GH) level of <2.5 microg/l, or a glucose-suppressed GH level of <1 microg/l following treatment have mortality figures indistinguishable from the general population. However, the confidence limits for these mortality estimates are quite wide. It remains possible that growth hormone levels lower than 1 microg/l for random samples, or even lower when using ultrasensitive GH assays, may indicate superior outcome, but this remains to be confirmed. There are limited data relating serum insulin-like growth factor-I (IGF-I) levels to outcome, although normalisation of serum IGF-I clearly improves outcome compared with continued elevation of measurements after treatment. Current evidence suggests that a post-treatment random serum GH <2.5 microg/l and a normal serum IGF-I value defines biochemical cure. Available data suggest that achieving similar growth hormone levels after treatment also reduces the prevalence of chronic complications of the disorder, which is subsequently reflected in improved mortality.
许多组织已经制定了指南，以表明肢端肥大症患者是否已通过治疗治愈。然而，迄今为止的研究并未基于与长期预后的相关性，对该疾病的生化缓解给出一个可靠的定义。现有数据表明，治疗后随机血清生长激素（GH）水平<2.5μg/L或葡萄糖抑制后GH水平<1μg/L的患者，其死亡率与普通人群无异。然而，这些死亡率估计的置信区间相当宽。对于随机样本，生长激素水平低于1μg/L，或者使用超灵敏GH检测时更低，仍有可能表明预后更好，但这仍有待证实。虽然血清胰岛素样生长因子-I（IGF-I）水平与预后相关的数据有限，但与治疗后测量值持续升高相比，血清IGF-I正常化显然能改善预后。目前的证据表明，治疗后随机血清GH<2.5μg/L且血清IGF-I值正常可定义为生化治愈。现有数据表明，治疗后达到相似的生长激素水平也会降低该疾病慢性并发症的患病率，这随后反映在死亡率的改善上。
