Foltyn Wanda, Kos-Kudla Beata, Strzelczyk Janusz, Matyja Violetta, Karpe Jacek, Rudnik Adam, Marek Bogdan, Kajdaniuk Dariusz, Sieron Aleksander, Latos Wojciech
Division of Endocrinology, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Zabrze, Poland.
Neuro Endocrinol Lett. 2008 Feb;29(1):107-12.
Pathogenesis of colonic lesions in patients with acromegaly remains still unclear. There are suggestions that apart from somatotropin axis hormones (GH and IGF-1), other agents also take part in this process. Molecular and animal studies indicate a vital role of hyperinsulinemia in development of colorectal neoplasms.
To evaluate a relation between insulin level, insulin resistance and its anthropometric markers and colorectal lesions in patients with acromegaly.
The study consisted of 40 patients with active, newly diagnosed acromegaly; 24 women and 16 men aged from 24 to 77 years (mean age 50.1, SD+/-12.1). The analysis included the results of somatotropin axis function (GH and IGF-1 level), carbohydrate metabolism assessment (fasting serum glucose and insulin levels, oral glucose tolerance test, HOMA-IR for insulin resistance), the results of anthropometric measurement (BMI, WHR) and colonoscopy.
Colon pathologies (60 polyps and 2 flat lesions) were discovered in 19 (47.5%) patients with acromegaly, 8 of them had multiple polyps. Hyperplastic polyps were revealed in 11 (27.5%), while adenomas in 8 (20%) acromegalics. Patients with colorectal lesions were found to have higher WHR then subjects with normal colon (p=0.033). Positive correlation between the number of hyperplastic polyps in the patients with multiple changes in the colon and IGF-1 (p=0.025), insulin level (p=0.005) and HOMA-IR (p=0.001) was found. Multiple adenomas correlated positively with insulin level (p=0.007), HOMA-IR (p=0.006) and BMI (p=0.015).
The study results show a relation between hyperinsulinemia, insulin resistance and colon pathologies in acromegaly. Fasting insulin level and HOMA-IR correlate positively with the number of hyperplastic polyps and adenomas in acromegalic patients with multiply colorectal lesions.
肢端肥大症患者结肠病变的发病机制仍不清楚。有观点认为，除了生长激素轴激素（生长激素和胰岛素样生长因子-1）外，其他因素也参与了这一过程。分子和动物研究表明，高胰岛素血症在结直肠肿瘤的发生发展中起着至关重要的作用。
评估肢端肥大症患者胰岛素水平、胰岛素抵抗及其人体测量指标与结肠病变之间的关系。
本研究包括40例新诊断的活动性肢端肥大症患者；其中24例女性，16例男性，年龄在24至77岁之间（平均年龄50.1岁，标准差±12.1）。分析内容包括生长激素轴功能结果（生长激素和胰岛素样生长因子-1水平）、碳水化合物代谢评估（空腹血清葡萄糖和胰岛素水平、口服葡萄糖耐量试验、胰岛素抵抗的稳态模型评估）、人体测量结果（体重指数、腰臀比）以及结肠镜检查结果。
在19例（47.5%）肢端肥大症患者中发现结肠病变（60个息肉和2个扁平病变），其中8例有多个息肉。11例（27.5%）发现增生性息肉，8例（20%）肢端肥大症患者发现腺瘤。发现结肠病变患者的腰臀比比结肠正常的受试者高（p=0.033）。在结肠有多处病变的患者中，增生性息肉数量与胰岛素样生长因子-1（p=0.025）、胰岛素水平（p=0.005）和稳态模型评估的胰岛素抵抗（p=0.001）呈正相关。多个腺瘤与胰岛素水平（p=0.007）、稳态模型评估的胰岛素抵抗（p=0.006）和体重指数（p=0.015）呈正相关。
研究结果表明肢端肥大症患者的高胰岛素血症、胰岛素抵抗与结肠病变之间存在关联。空腹胰岛素水平和稳态模型评估的胰岛素抵抗与有多发性结肠病变的肢端肥大症患者增生性息肉和腺瘤的数量呈正相关。
