Department of Endocrinology, The Christie National Health Service Foundation Trust, Manchester M20 4BX, United Kingdom.
J Clin Endocrinol Metab. 2011 May;96(5):1486-92. doi: 10.1210/jc.2010-2225. Epub 2011 Feb 23.
Acromegaly increases cardiovascular morbidity. We tested the hypothesis that increased arterial stiffness together with left ventricular hypertrophy may be a contributory factor.
Fifty-six patients (40 males, 54 ± 13 yr; 25 active disease, 31 in remission) and 46 healthy controls (30 males, 52 ± 13 yr) underwent measurements of aortic pulse wave velocity (PWV), carotid Doppler (IMT), echocardiography, and cardiovascular risk factors.
Mean serum IGF-I was 323 ± 286 ng/ml (sd score 1.8 ± 1.9) in all patients. Age, body mass index, diastolic blood pressure (BP), and lipid levels were similar comparing patients and controls. Systolic BP (130.8 ± 19.9 vs. 122 ± 14 mm Hg controls, P < 0.01) and PWV (11.7 ± 3.8 vs. 9.7 ± 2.8 m/sec, 95% confidence interval -3.4 to -0.7, P <0.01) were higher in patients than controls. Regression analysis revealed age, presence of acromegaly, systolic BP, and body mass index, inversely, as significantly and independently associated with PWV. No difference in carotid IMT was seen (0.8 ± 0.2 patients vs. 0.7 ± 0.2 mm controls, P = 0.5) or between active/controlled disease. In the subset of participants with echocardiography (n = 32), left ventricular mass was higher by a mean of 38.2 g (95% confidence interval -80.9 to +4.6, P = 0.08).
In summary, patients with acromegaly had independently and significantly increased aortic PWV as evidence of arterial stiffening but unaltered carotid IMT compared with controls, also influenced by age and systolic BP. Premature cardiovascular disease in patients with acromegaly is likely related to pressure-related arterial and left ventricular stiffening rather than atherosclerotic disease.
肢端肥大症会增加心血管发病率。我们验证了一个假设，即动脉僵硬度增加伴左心室肥厚可能是一个促成因素。
56 名患者（40 名男性，54 ± 13 岁；25 名疾病活跃，31 名缓解）和 46 名健康对照者（30 名男性，52 ± 13 岁）接受了主动脉脉搏波速度（PWV）、颈动脉多普勒（IMT）、超声心动图和心血管危险因素的测量。
所有患者的平均血清 IGF-I 为 323 ± 286 ng/ml（标准差分数 1.8 ± 1.9）。患者和对照组的年龄、体重指数、舒张压（BP）和血脂水平相似。与对照组相比，收缩压（130.8 ± 19.9 比 122 ± 14 mm Hg，P < 0.01）和 PWV（11.7 ± 3.8 比 9.7 ± 2.8 m/sec，95%置信区间-3.4 至-0.7，P < 0.01）在患者中更高。回归分析显示，年龄、肢端肥大症的存在、收缩压和体重指数与 PWV 呈负相关，且具有显著的独立相关性。颈动脉 IMT 无差异（0.8 ± 0.2 患者 vs. 0.7 ± 0.2 mm 对照组，P = 0.5）或在活跃/控制疾病之间。在有超声心动图的参与者亚组（n = 32）中，左心室质量平均增加 38.2 g（95%置信区间-80.9 至+4.6，P = 0.08）。
总之，肢端肥大症患者的主动脉 PWV 独立且显著增加，表明动脉僵硬度增加，但与对照组相比，颈动脉 IMT 无变化，这也受年龄和收缩压的影响。肢端肥大症患者的早期心血管疾病可能与压力相关的动脉和左心室僵硬度增加有关，而不是动脉粥样硬化性疾病。
