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手术控制的肢端肥大症患者术后代谢参数的变化:新的严格治愈标准评估

Postoperative Changes in Metabolic Parameters of Patients with Surgically Controlled Acromegaly: Assessment of New Stringent Cure Criteria.

作者信息

Yonenaga Masanori, Fujio Shingo, Habu Mika, Arimura Hiroshi, Hiwatari Takaaki, Tanaka Shunichi, Kinoshita Yasuyuki, Hosoyama Hiroshi, Hirano Hirofumi, Arita Kazunori

机构信息

Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University.

Department of Diabetes and Endocrine Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University.

出版信息

Neurol Med Chir (Tokyo). 2018 Apr 15;58(4):147-155. doi: 10.2176/nmc.oa.2017-0215. Epub 2018 Feb 23.

Abstract

The criteria for surgical cure of acromegaly have become more stringent during the past decades and a change from Cortina to new consensus criteria has recently been proposed. However, the superiority of the new consensus over Cortina criteria with respect to postoperative metabolic parameters remains to be ascertained. We retrospectively assessed metabolic parameters, the body habitus, and other health-related parameters of 48 patients with surgically controlled acromegaly who met the Cortina criteria [normalized insulin-like growth factor-1 (IGF-1) level and nadir growth hormone (GH) level <1.0 ng/ml during postoperative oral glucose tolerance test]. The 48 patients were divided into two groups. Group A (n = 33) met the new consensus criteria (normalized IGF-1 and nadir GH level <0.4 ng/ml). Group B (n = 15) met Cortina criteria, but their nadir GH ranged from 0.4 to 1.0 ng/ml. In both groups, the level of triglyceride and homeostasis model assessment-insulin resistance (HOMA-IR) was significantly decreased 1 year after the operation (P < 0.05). High-density lipoprotein cholesterol showed a significant increase only in group B (P = 0.02). However, the two groups did not differ with respect to the postoperative improvement rate of these parameters and the other health-related parameters including body mass index, blood pressure, anterior pituitary function, and self-estimated quality of life scale. In conclusion, our findings show that with respect to changes in metabolic parameters and the body habitus assessed 1 year after surgery, the stricter consensus criteria seemed not to be superior to Cortina criteria.

摘要

在过去几十年中,肢端肥大症手术治愈的标准变得更加严格,最近有人提议从科尔蒂纳标准转变为新的共识标准。然而,新的共识标准在术后代谢参数方面相对于科尔蒂纳标准的优越性仍有待确定。我们回顾性评估了48例手术控制的肢端肥大症患者的代谢参数、身体形态和其他健康相关参数,这些患者符合科尔蒂纳标准[术后口服葡萄糖耐量试验期间胰岛素样生长因子-1(IGF-1)水平正常化且生长激素(GH)最低点水平<1.0 ng/ml]。这48例患者分为两组。A组(n = 33)符合新的共识标准(IGF-1正常化且GH最低点水平<0.4 ng/ml)。B组(n = 15)符合科尔蒂纳标准,但其GH最低点范围为0.4至1.0 ng/ml。两组患者术后1年甘油三酯水平和稳态模型评估胰岛素抵抗(HOMA-IR)均显著降低(P < 0.05)。高密度脂蛋白胆固醇仅在B组显著升高(P = 0.02)。然而,两组在这些参数的术后改善率以及包括体重指数、血压、垂体前叶功能和自我评估生活质量量表在内的其他健康相关参数方面并无差异。总之,我们的研究结果表明,就术后1年评估的代谢参数和身体形态变化而言,更严格的共识标准似乎并不优于科尔蒂纳标准。

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