Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
Nordic Health Economics, Gothenburg, Sweden.
Eur J Endocrinol. 2018 May;178(5):459-469. doi: 10.1530/EJE-18-0015. Epub 2018 Feb 26.
New therapeutic strategies have developed for the management of acromegaly over recent decades. Whether this has improved mortality has not been fully elucidated.
The primary aim was to investigate mortality in a nationwide unselected cohort of patients with acromegaly. Secondary analyses included time trends in mortality and treatment patterns.
A total of 1089 patients with acromegaly were identified in Swedish National Health Registries between 1987 and 2013. To analyse time trends, the cohort was divided into three periods (1987-1995, 1996-2004 and 2005-2013) based on the year of diagnosis.
Using the Swedish population as reference, standardized mortality ratios (SMRs) were calculated with 95% confidence intervals (CIs).
Overall SMR was 2.79 (95% CI: 2.43-3.15) with 232 observed and 83 expected deaths. Mortality was mainly related to circulatory diseases (SMR: 2.95, 95% CI: 2.35-3.55), including ischemic heart disease (2.00, 1.35-2.66) and cerebrovascular disease (3.99, 2.42-5.55) and malignancy (1.76, 1.27-2.26). Mortality decreased over time, with an SMR of 3.45 (2.87-4.02) and 1.86 (1.04-2.67) during the first and last time period, respectively ( = .015). During the same time periods, the frequency of pituitary surgery increased from 58% to 72% ( < 0.001) and the prevalence of hypopituitarism decreased from 41% to 23% ( < 0.001).
Excess mortality was found in this nationwide cohort of patients with acromegaly, mainly related to circulatory and malignant diseases. Although still high, mortality significantly declined over time. This could be explained by the more frequent use of pituitary surgery, decreased prevalence of hypopituitarism and the availability of new medical treatment options.
近几十年来，针对肢端肥大症的治疗策略不断发展。但这是否能降低死亡率仍未得到充分阐明。
本研究旨在调查肢端肥大症患者在全国未选择的队列中的死亡率。次要分析包括死亡率的时间趋势和治疗模式。
在 1987 年至 2013 年间，通过瑞典国家健康登记处确定了 1089 例肢端肥大症患者。为了分析时间趋势，该队列根据诊断年份分为三个时期（1987-1995 年、1996-2004 年和 2005-2013 年）。
使用瑞典人群作为参考，计算标准化死亡率比（SMR）及其 95%置信区间（CI）。
总 SMR 为 2.79（95%CI：2.43-3.15），观察到 232 例死亡，预期死亡 83 例。死亡率主要与循环系统疾病相关（SMR：2.95，95%CI：2.35-3.55），包括缺血性心脏病（2.00，1.35-2.66）和脑血管疾病（3.99，2.42-5.55）和恶性肿瘤（1.76，1.27-2.26）。随着时间的推移，死亡率呈下降趋势，第一和最后时间段的 SMR 分别为 3.45（2.87-4.02）和 1.86（1.04-2.67）（=0.015）。在此期间，垂体手术的频率从 58%增加到 72%（<0.001），垂体功能减退症的患病率从 41%降至 23%（<0.001）。
在全国肢端肥大症患者的这一队列中发现了死亡率过高的情况，主要与循环系统和恶性疾病有关。尽管死亡率仍然很高，但随着时间的推移，死亡率显著下降。这可能是由于垂体手术的使用更频繁、垂体功能减退症的患病率降低以及新的医疗治疗选择的出现。
