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肢端肥大症患者肺部结构异常的患病率及其与气体交换的关系:一项有对照组的横断面分析研究

Prevalence of lung structure abnormalities in patients with acromegaly and their relationship with gas exchange: cross-sectional analytical study with a control group.

作者信息

Rodrigues Marcelo Palmeira, Naves Luciana Ansaneli, Viegas Carlos Alberto, Melo-Silva Cesar Augusto, de Paula Wagner Diniz, Cabral Márcia Teixeira, Araújo Renata Rodrigues, Casulari Luiz Augusto

机构信息

School of Medicine, Universidade de Brasília, Brasília, Brasil.

Department of Pneumology, Hospital Universitário de Brasília, Brasília, Brasil.

出版信息

Sao Paulo Med J. 2015 Sep-Oct;133(5):394-400. doi: 10.1590/1516-3180.2013.7640012. Epub 2014 Sep 19.

Abstract

CONTEXT AND OBJECTIVE

Different functional respiratory alterations have been described in acromegaly, but their relationship with pulmonary tissue abnormalities is unknown. The objective of this study was to observe possible changes in lung structure and explain their relationship with gas exchange abnormalities.

DESIGN AND SETTING

Cross-sectional analytical study with a control group, conducted at a university hospital.

METHODS

The study included 36 patients with acromegaly and 24 controls who were all assessed through high-resolution computed tomography of the thorax (CT). Arterial blood gas, effort oximetry and serum growth hormone (GH) and insulin-like growth factor I (IGF-1) were also assessed in the patients with acromegaly.

RESULTS

The abnormalities found in the CT scan were not statistically different between the acromegaly and control groups: mild cylindrical bronchiectasis (P = 0.59), linear opacity (P = 0.29), nodular opacity (P = 0.28), increased attenuation (frosted glass; P = 0.48) and decreased attenuation (emphysema; P = 0.32). Radiographic abnormalities were not associated with serum GH and IGF-1. Hypoxemia was present in seven patients; however, in six of them, the hypoxemia could be explained by underlying clinical conditions other than acromegaly: chronic obstructive pulmonary disease in two, obesity in two, bronchial infection in one and asthma in one.

CONCLUSION

No changes in lung structure were detected through thorax tomography in comparison with the control subjects. The functional respiratory alterations found were largely explained by alternative diagnoses or had subclinical manifestations, without any plausible relationship with lung structural factors.

摘要

背景与目的

肢端肥大症患者存在不同的功能性呼吸改变,但其与肺组织异常之间的关系尚不清楚。本研究的目的是观察肺部结构可能存在的变化,并解释其与气体交换异常之间的关系。

设计与地点

在一家大学医院进行的有对照组的横断面分析研究。

方法

本研究纳入了36例肢端肥大症患者和24例对照者,所有受试者均接受了胸部高分辨率计算机断层扫描(CT)检查。对肢端肥大症患者还进行了动脉血气分析、运动血氧饱和度测定以及血清生长激素(GH)和胰岛素样生长因子I(IGF-1)检测。

结果

肢端肥大症组与对照组在CT扫描中发现的异常无统计学差异:轻度柱状支气管扩张(P = 0.59)、线状阴影(P = 0.29)、结节状阴影(P = 0.28)、密度增加(磨砂玻璃样;P = 0.48)和密度降低(肺气肿;P = 0.32)。影像学异常与血清GH和IGF-1无关。7例患者存在低氧血症;然而,其中6例患者的低氧血症可由肢端肥大症以外的潜在临床疾病解释:慢性阻塞性肺疾病2例、肥胖2例、支气管感染1例和哮喘1例。

结论

与对照受试者相比,胸部断层扫描未检测到肺部结构的变化。所发现的功能性呼吸改变在很大程度上可由其他诊断解释或具有亚临床症状,与肺部结构因素无明显关联。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b655/10871800/f3bede5a9be4/1516-3180-spmj-133-05-00394-gf01.jpg

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