Tauber J P, Poncet M F, Harris A G, Barthel H R, Simonetta-Chateauneuf C, Buscail L, Bayard F
Service d'Endocrinologie et de Diabetologie, Centre Hospitalo Universitaire Rangueil, University of Toulouse, France.
J Clin Endocrinol Metab. 1995 Nov;80(11):3262-6. doi: 10.1210/jcem.80.11.7593435.
Treatment of acromegaly with intermittent sc injections of octreotide is associated with an increased incidence of cholelithiasis. We investigated the incidence of gallstone formation, the occurrence of gallbladder disease, and the response of gallstones to ursodeoxycholic acid in 30 acromegalic patients who were treated with a continuous sc infusion of octreotide at doses between 200 and 800 micrograms/day for 3-70 months. Of the 30 patients, 28 had pretretment ultrasonography of the biliary tree performed, and all had frequent follow-ups. Nine patients underwent pre- and posttreatment bile sampling. No patient treated for less than 6 months and 18.5% of patients treated for more than 6 months developed new gallstones. No patient developed symptomatic cholelithiasis while receiving octreotide therapy. Of six patients who developed gallstones, four were treated with ursodeoxycholic acid, which dissolved all gallstones. One patient with gallstones experienced an episode of biliary colic when octreotide was withdrawn; however, no cholecystitis was found at subsequent cholecystectomy. Bile sampling showed that 8 (75%) of the 12 patients who were assessed demonstrated microcrystals, whereas in 3 (50%) of 6 patients who were closely analyzed thereafter, microcrystals disappeared once octreotide therapy was stopped. Our results show that continuous sc infusion octreotide therapy increases the incidence of cholelithiasis over normal values, as is the case with intermittent sc injections. Although higher octreotide levels are sustained with continuous sc infusion, this is not associated with an increased risk of gallstone formation compared with intermittent sc octreotide therapy.
用奥曲肽间断皮下注射治疗肢端肥大症与胆结石发病率增加有关。我们调查了30例肢端肥大症患者的胆结石形成发生率、胆囊疾病的发生情况以及胆结石对熊去氧胆酸的反应。这些患者接受了奥曲肽皮下持续输注治疗，剂量为每日200至800微克，治疗时间为3至70个月。30例患者中，28例在治疗前进行了胆道超声检查，且均接受了频繁的随访。9例患者进行了治疗前后的胆汁采样。治疗时间少于6个月的患者未出现新的胆结石，治疗时间超过6个月的患者中有18.5%出现了新的胆结石。在接受奥曲肽治疗期间，没有患者出现有症状的胆结石。6例出现胆结石的患者中，4例接受了熊去氧胆酸治疗，所有胆结石均溶解。1例胆结石患者在停用奥曲肽时发生了一次胆绞痛；然而，在随后的胆囊切除术中未发现胆囊炎。胆汁采样显示，在接受评估的12例患者中，有8例（75%）出现了微晶，而在随后进行密切分析的6例患者中，有3例（50%）在停用奥曲肽治疗后微晶消失。我们的结果表明，与间断皮下注射的情况一样，奥曲肽皮下持续输注治疗会使胆结石发病率高于正常值。尽管皮下持续输注能维持较高的奥曲肽水平，但与奥曲肽间断皮下注射治疗相比，这与胆结石形成风险增加无关。
