Bates A S, Van't Hoff W, Jones J M, Clayton R N
Department of Diabetes and Endocrinology, North Staffordshire Royal Infirmary, Hartshill, Stoke-on-Trent, Staffordshire.
Q J Med. 1993 May;86(5):293-9.
In order to determine whether acromegaly is still associated with increased mortality, a hospital case note review of all patients with acromegaly followed up in Stoke-on-Trent since 1967 was carried out. Of 79 subjects identified, 51 are alive and being monitored and 28 have died. Mortality was compared to the general population by life table analysis. Secretion of growth hormone was assessed and compared in dead and alive patients. The effect of diabetes, hypertension, and growth hormone secretion on long-term outcome was assessed. Acromegaly is still associated with increased mortality, with an overall ratio of observed to expected deaths equal to 2.68 (95% C.I. 1.8-3.9; p < 0.001), but the survival of 31 (39%) patients whose growth hormone level had been reduced to below 5 mU/l was equal to that of the general population (O/E = 1.42; 95% C.I. 0.46-3.31: p > 0.05). The dead patients had had significantly higher growth hormone levels than those still alive, but mortality did not appear to be influenced by diabetes or hypertension. The cause of death was vascular in 57% of cases. Growth hormone hypersecretion is still associated with excess mortality in acromegaly. The present study suggests that the therapeutic objective should be to lower average daytime growth hormone levels to less than 5 mU/l. There is need for a large study to compare different modes of treatment in terms of their effect on growth hormone secretion and on long-term outcome.
为了确定肢端肥大症是否仍与死亡率增加相关，我们对自1967年以来在特伦特河畔斯托克接受随访的所有肢端肥大症患者的医院病历进行了回顾。在确定的79名患者中，51名存活且正在接受监测，28名已经死亡。通过生命表分析将死亡率与普通人群进行比较。评估并比较了死亡患者和存活患者的生长激素分泌情况。评估了糖尿病、高血压和生长激素分泌对长期预后的影响。肢端肥大症仍与死亡率增加相关，观察到的死亡与预期死亡的总体比率为2.68（95%置信区间1.8 - 3.9；p < 0.001），但31名（39%）生长激素水平已降至5 mU/l以下的患者的生存率与普通人群相当（观察/预期 = 1.42；95%置信区间0.46 - 3.31：p > 0.05）。死亡患者的生长激素水平显著高于仍存活的患者，但死亡率似乎不受糖尿病或高血压的影响。57%的病例死亡原因是血管性的。肢端肥大症中生长激素分泌过多仍与过高的死亡率相关。本研究表明治疗目标应为将白天平均生长激素水平降低至低于5 mU/l。需要进行一项大型研究来比较不同治疗方式对生长激素分泌和长期预后的影响。
