Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse, F-94275, Le Kremlin Bicêtre, France.
Institut MITOVASC, INSERM U1083, Université d'Angers, Département d'Endocrinologie, Diabétologie et Nutrition, Centre Hospitalier Universitaire d'Angers, F-49933, Angers, France.
Endocrine. 2019 Feb;63(2):348-360. doi: 10.1007/s12020-018-1797-8. Epub 2018 Nov 5.
Untreated acromegaly is associated with increased morbidity and mortality due to malignant, cardiovascular, and cerebrovascular disorders. Effective treatment of acromegaly reduces excess mortality, but its impact on cardiovascular risk factors and metabolic parameters are poorly documented.
We analyzed changes in cardiovascular risk factors and metabolic parameters in patients receiving various treatment modalities.
We retrospectively studied 96 patients with acromegaly, both at diagnosis and after IGF-I normalization following surgery alone (n = 51) or medical therapy with first generation somatostatin analogues (SSA, n = 23), or pegvisomant (n = 22). Duration of follow-up was 77 (42-161) months, 75 (42-112) months, and 62 (31-93) months, in patients treated with surgery alone, SSA, and pegvisomant, respectively. In all the cases except four, patients treated medically had underwent previous unsuccessful surgery.
IGF-I normalization was associated with increased body weight, decreased systolic blood pressure (SBP) in hypertensive patients, decreased fasting plasma glucose (FPG) and HOMA-IR and HOMA-B levels, increased HDL cholesterol (HDLc); whereas, LDL cholesterol (LDLc) was not significantly different. Plasma PCSK9 levels were unchanged in patients with available values. Cardiovascular and metabolic changes varied with the treatment modality: surgery, but not pegvisomant, had a beneficial effect on SBP; FPG decreased after surgery but increased after SSA; the decline in HOMA-IR was only significant after surgery; pegvisomant significantly increased LDLc and total cholesterol; whereas SA increased HDLc and had no effect on LDLc levels.
Treatments used to normalize IGF-I levels in patients with acromegaly could have differential effects on cardiovascular risk factors and metabolic parameters.
未经治疗的肢端肥大症可导致恶性疾病、心血管和脑血管疾病，从而使发病率和死亡率增加。肢端肥大症的有效治疗可降低过度死亡率，但关于其对心血管危险因素和代谢参数的影响的记录很少。
我们分析了接受不同治疗方式的肢端肥大症患者的心血管危险因素和代谢参数的变化。
我们回顾性研究了 96 例肢端肥大症患者，这些患者在单独接受手术（n=51）或第一代生长抑素类似物（SSA，n=23）或培维索孟（n=22）药物治疗后 IGF-I 恢复正常。单独接受手术、SSA 和培维索孟治疗的患者的随访时间分别为 77（42-161）、75（42-112）和 62（31-93）个月。除了 4 例患者外，所有接受药物治疗的患者都曾接受过不成功的手术。
IGF-I 正常化与体重增加、高血压患者的收缩压（SBP）降低、空腹血糖（FPG）、HOMA-IR 和 HOMA-B 水平降低、高密度脂蛋白胆固醇（HDLc）升高有关；而 LDL 胆固醇（LDLc）没有显著差异。有可用值的患者中，血浆 PCSK9 水平没有变化。心血管和代谢变化因治疗方式而异：手术而非培维索孟对 SBP 有有益的影响；FPG 在手术后降低，但在 SSA 后升高；HOMA-IR 的下降仅在手术后才具有统计学意义；培维索孟显著增加 LDLc 和总胆固醇；而 SSA 增加了 HDLc，对 LDLc 水平没有影响。
用于使肢端肥大症患者 IGF-I 水平正常化的治疗方法可能对心血管危险因素和代谢参数产生不同的影响。
