Dal Jakob, Feldt-Rasmussen Ulla, Andersen Marianne, Kristensen Lars Ø, Laurberg Peter, Pedersen Lars, Dekkers Olaf M, Sørensen Henrik Toft, Jørgensen Jens Otto L
Department of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, Denmark
Department of EndocrinologyNational University Hospital, Copenhagen, Denmark.
Eur J Endocrinol. 2016 Sep;175(3):181-90. doi: 10.1530/EJE-16-0117. Epub 2016 Jun 8.
Valid data on acromegaly incidence, complications and mortality are scarce. The Danish Health Care System enables nationwide studies with complete follow-up and linkage among health-related databases to assess acromegaly incidence, prevalence, complications and mortality in a population-based cohort study.
All incident cases of acromegaly in Denmark (1991-2010) were identified from health registries and validated by chart review. We estimated the annual incidence rate of acromegaly per 10(6) person-years (py) with 95% confidence intervals (95% CIs). For every patient, 10 persons were sampled from the general population as a comparison cohort. Cox regression and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used.
Mean age at diagnosis (48.7 years (CI: 95%: 47.2-50.1)) and annual incidence rate (3.8 cases/10(6) persons (95% CI: 3.6-4.1)) among the 405 cases remained stable. The prevalence in 2010 was 85 cases/10(6) persons. The patients were at increased risk of diabetes mellitus (HR: 4.0 (95% CI: 2.7-5.8)), heart failure (HR: 2.5 (95% CI: 1.4-4.5)), venous thromboembolism (HR: 2.3 (95% CI: 1.1-5.0)), sleep apnoea (HR: 11.7 (95% CI: 7.0-19.4)) and arthropathy (HR: 2.1 (95% CI: 1.6-2.6)). The complication risk was also increased before the diagnosis of acromegaly. Overall mortality risk was elevated (HR: 1.3 (95% CI: 1.0-1.7)) but uninfluenced by treatment modality.
(i) The incidence rate and age at diagnosis of acromegaly have been stable over decades, and the prevalence is higher than previously reported. (ii) The risk of complications is very high even before the diagnosis. (iii) Mortality risk remains elevated but uninfluenced by mode of treatment.
关于肢端肥大症发病率、并发症及死亡率的有效数据稀缺。丹麦医疗保健系统使开展全国性研究成为可能，可进行完整随访并将健康相关数据库相互关联，以在一项基于人群的队列研究中评估肢端肥大症的发病率、患病率、并发症及死亡率。
从健康登记处识别出丹麦1991年至2010年期间所有肢端肥大症的新发病例，并通过病历审查进行验证。我们估算了每10^6人年的肢端肥大症年发病率，并给出95%置信区间（95%CI）。对于每位患者，从普通人群中抽取10人作为对照队列。使用Cox回归及带有95%置信区间（95%CI）的风险比（HR）。
405例患者的诊断时平均年龄（48.7岁（CI：95%：47.2 - 50.1））及年发病率（3.8例/10^6人（95%CI：3.6 - 4.1））保持稳定。2010年的患病率为85例/10^6人。患者患糖尿病（HR：4.0（95%CI：2.7 - 5.8））、心力衰竭（HR：2.5（95%CI：1.4 - 4.5））、静脉血栓栓塞（HR：2.3（95%CI：1.1 - 5.0））、睡眠呼吸暂停（HR：11.7（95%CI：7.0 - 19.4））及关节病（HR：2.1（95%CI：1.6 - 2.6））的风险增加。在肢端肥大症诊断之前，并发症风险也有所增加。总体死亡风险升高（HR：1.3（95%CI：1.0 - 1.7）），但不受治疗方式影响。
（i）肢端肥大症的发病率及诊断年龄在数十年间保持稳定，且患病率高于先前报道。（ii）甚至在诊断之前，并发症风险就非常高。（iii）死亡风险仍然升高，但不受治疗方式影响。
