手术治愈肢端肥大症患者中 GH 缺乏的临床预测因子。

Clinical predictors of GH deficiency in surgically cured acromegalic patients.

机构信息

EndocrinologyInstitute of Endocrine ResearchPituitary Tumor ClinicNeurosurgeryYonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of KoreaDepartment of Internal MedicineIlsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of KoreaEndocrinologyInstitute of Endocrine ResearchPituitary Tumor ClinicNeurosurgeryYonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of KoreaDepartment of Internal MedicineIlsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of KoreaEndocrinologyInstitute of Endocrine ResearchPituitary Tumor ClinicNeurosurgeryYonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of KoreaDepartment of Internal MedicineIlsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea.

出版信息

Eur J Endocrinol. 2014 Sep;171(3):379-87. doi: 10.1530/EJE-14-0304. Epub 2014 Jun 27.

DOI:10.1530/EJE-14-0304

PMID:24972779

Abstract

OBJECTIVE

Even in patients with cured acromegaly, GH deficiency (GHD) after transsphenoidal adenomectomy (TSA) adversely affects body composition and inflammatory biomarkers of cardiovascular risk. In this study, clinical parameters for predicting GHD after TSA in 123 cured acromegalic patients were investigated.

DESIGN AND METHODS

GH levels were measured at 6, 12, 18, 24, 48, and 72 h after TSA and serial insulin tolerance tests were conducted at 6 months, 2 years, and then every 2 years after TSA.

RESULTS

GHD was found in 12 patients (9.8%) at 4.1 (range: 0.5-4.1) years after TSA. IGF1 levels were significantly lower at 6 months after TSA in GHD group than intact GH group (175.9 vs 316.8 μg/l, range: 32.0-425.0 and 96.9-547.3 respectively, P=0.008). Adenomas involving both sides of the pituitary gland were significantly more frequent in GHD patients (29.7 vs 83.3%; P=0.002). Furthermore, immediate postoperative 72-h GH levels after TSA were significantly lower (0.17 vs 0.45, range: 0.02-0.93 and 0.02-5.95 respectively, P=0.019) in GHD patients. In multiple logistic regression analysis, bilaterality of tumor involvement (odds ratio (OR)=10.678, P=0.003; 95% CI=2.248-50.728) and immediate postoperative 72-h GH level (OR=0.079, P=0.047; 95% CI=0.006-0.967) showed significant power for predicting GHD.

CONCLUSIONS

These data suggest that bilateral involvement of a pituitary adenoma and severely decreased immediate postoperative serum GH levels at 72 h after TSA may be independent risks factor for accelerated GHD in acromegalic patients.

摘要

目的

即使在经蝶窦腺瘤切除术（TSA）治愈的肢端肥大症患者中，术后生长激素缺乏（GHD）也会对身体成分和心血管风险的炎症生物标志物产生不利影响。本研究旨在探讨 123 例治愈的肢端肥大症患者 TSA 后发生 GHD 的临床预测参数。

设计和方法

在 TSA 后 6、12、18、24、48 和 72 小时测量 GH 水平，并在 TSA 后 6 个月、2 年以及此后每 2 年进行胰岛素耐量试验。

结果

在 TSA 后 4.1 年（范围：0.5-4.1 年）发现 12 例（9.8%）患者存在 GHD。GHD 组患者 TSA 后 6 个月 IGF1 水平明显低于 GH 完整组（175.9 与 316.8μg/l，范围：32.0-425.0 和 96.9-547.3，分别为 P=0.008）。GHD 患者中，垂体两侧肿瘤累及的比例明显更高（29.7%与 83.3%，P=0.002）。此外，TSA 后即刻术后 72 小时 GH 水平明显较低（0.17 与 0.45，范围：0.02-0.93 和 0.02-5.95，P=0.019）。多元逻辑回归分析显示，肿瘤累及的双侧性（优势比（OR）=10.678，P=0.003；95%可信区间（CI）=2.248-50.728）和术后即刻 72 小时 GH 水平（OR=0.079，P=0.047；95%CI=0.006-0.967）是预测 GHD 的独立危险因素。