Xie Zhengxing, Zhuang Yan, Zhang Zongqiang, Liu Jieping
Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China.
Neuro-Endoscope and Mini-Invasive Treatment Center, The Affiliated Hospital of Jiangsu University, Zhenjiang, China.
Front Oncol. 2022 Nov 24;12:948971. doi: 10.3389/fonc.2022.948971. eCollection 2022.
Cognitive decline in acromegaly has gained increasing attention. Cerebral microbleeds (CMBs) as radiographic markers for microvascular injury have been linked to various types of cognitive decline. However, the association between CMB formation and acromegaly has not yet been quantified. This study is designed to investigate the prevalence and the radiographic patterns of CMBs and the association between cognitive function and acromegaly-related CMBs in growth hormone (GH)-secreting pituitary adenoma, which is characterized by acromegaly.
In a cohort of 55 patients with GH-secreting pituitary adenoma (acromegaly) and 70 healthy control (HC) patients, we determined the presence of CMBs using a 3.0-T MRI scanner. The numbers, locations, and grades of CMBs were determined susceptibility-weighted imaging (SWI) and the Microbleed Anatomical Rating Scale. Obstructive sleep apnea (OSA) was assessed using the criteria of the American Academy of Sleep Medicine (AASM) Scoring Manual Version 2.2. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance within 3 days of admission. The association between CMBs and cognitive function as well as clinical characteristics was explored.
The incidence of CMBs was 29.1%, whereas that of OSA was 65.5% in acromegaly. There was a statistically significant difference in the prevalence of CMBs between subjects with and without acromegaly (29.1% and 5.3%, respectively) ( < 0.01). The age of acromegaly patients with CMBs was much younger compared with HCs with CMBs. Compared with HCs, a significant cognitive decline and the occurrence of OSA were demonstrated in patients with acromegaly ( < 0.01). Binary logistic regression analysis adjusted for age, education, and body mass index (BMI) revealed that CMB was an independent risk factor for cognitive impairment in patients with acromegaly (OR = 3.19, 95% CI 1.51-6.76, = 0.002). Furthermore, in the logistic regression models adjusted for age, BMI, diabetes, and hypertension, OSA was independently associated with the occurrence of CMBs in patients with acromegaly (OR = 13.34, 95% CI 3.09-57.51, = 0.001).
A significant increase of CMBs was demonstrated in patients with acromegaly, which may be a result of OSA in acromegaly. The present study indicated that increasing CMBs are responsible for cognitive decline in patients with acromegaly.
肢端肥大症患者的认知功能减退日益受到关注。脑微出血（CMBs）作为微血管损伤的影像学标志物，已与多种类型的认知功能减退相关联。然而，CMB形成与肢端肥大症之间的关联尚未得到量化。本研究旨在调查生长激素（GH）分泌型垂体腺瘤（以肢端肥大症为特征）患者中CMBs的患病率、影像学特征以及认知功能与肢端肥大症相关CMBs之间的关联。
在一组55例GH分泌型垂体腺瘤（肢端肥大症）患者和70例健康对照（HC）患者中，我们使用3.0-T MRI扫描仪确定CMBs的存在情况。通过磁敏感加权成像（SWI）和微出血解剖评分量表确定CMBs的数量、位置和分级。使用美国睡眠医学学会（AASM）评分手册第2.2版的标准评估阻塞性睡眠呼吸暂停（OSA）。在入院3天内使用蒙特利尔认知评估量表（MoCA）评估认知表现。探讨CMBs与认知功能以及临床特征之间的关联。
肢端肥大症患者中CMBs的发生率为29.1%，而OSA的发生率为65.5%。有肢端肥大症和无肢端肥大症患者之间CMBs的患病率存在统计学显著差异（分别为29.1%和5.3%）（P<0.01）。与有CMBs的HC患者相比，有CMBs的肢端肥大症患者年龄要年轻得多。与HC患者相比，肢端肥大症患者表现出显著的认知功能减退和OSA的发生（P<0.01）。对年龄、教育程度和体重指数（BMI）进行校正的二元逻辑回归分析显示，CMB是肢端肥大症患者认知障碍的独立危险因素（OR = 3.19，95%CI 1.51 - 6.76，P = 0.002）。此外，在对年龄、BMI、糖尿病和高血压进行校正的逻辑回归模型中，OSA与肢端肥大症患者CMBs的发生独立相关（OR = 13.34，95%CI 3.09 - 57.51，P = 0.001）。
肢端肥大症患者中CMBs显著增加，这可能是肢端肥大症中OSA的结果。本研究表明，CMBs增加是肢端肥大症患者认知功能减退的原因。
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