Jasper H, Chervin A, Vitale M, Mella A, Ropelato G, Basso A
División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.
Medicina (B Aires). 1994;54(1):25-30.
Against a clinical score we compared the effectiveness of three biochemical markers of acromegalic activity: a) growth hormone response to i.v. thyrotropin-releasing hormone, b) growth hormone suppression one hour after an oral glucose load, c) basal plasma IGF-I levels. In 21 patients we obtained 39 observations comprising the four parameters. According to the clinical score, patients were divided into three groups: group I = patients before surgery; group II = improved but still clinically active; group III = clinically inactive. After i.v. thyrotropin-releasing hormone, abnormal observations increased although the patients improved clinically, so that this test was excluded from statistical analysis. Abnormalities in plasma IGF-I levels and in GH suppression after oral glucose were similarly frequent in the groups studied: both 100% in group I, both 71.4% in group II, 27.3% vs. 18.2% in group III (p > 0.05). Both tests made exactly the same contribution to the other's capacity to detect acromegalic activity: 3 out of 39 observations (5.1%). We conclude that basal plasma IGF-I is the single best biochemical marker to detect acromegalic activity, since it is statistically at least as useful as growth hormone suppression, and is far more simple for the patient and the laboratory.
a）静脉注射促甲状腺激素释放激素后的生长激素反应；b）口服葡萄糖负荷后一小时的生长激素抑制情况；c）基础血浆胰岛素样生长因子-I（IGF-I）水平。我们对21例患者进行了观察，共获得包含这四个参数的39项观测结果。根据临床评分，患者被分为三组：第一组 = 手术前患者；第二组 = 病情改善但仍有临床活动；第三组 = 临床无活动。静脉注射促甲状腺激素释放激素后，尽管患者临床症状有所改善，但异常观测结果增加，因此该测试被排除在统计分析之外。在所研究的各组中，血浆IGF-I水平异常和口服葡萄糖后生长激素抑制异常的情况同样常见：第一组两者均为100%，第二组两者均为71.4%，第三组分别为27.3%和18.2%（p>0.05）。这两项测试对彼此检测肢端肥大症活性的能力贡献完全相同：39项观测结果中有3项（5.1%）。我们得出结论，基础血浆IGF-I是检测肢端肥大症活性的单一最佳生化标志物，因为从统计学角度看，它至少与生长激素抑制一样有用，而且对患者和实验室来说都要简单得多。
