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| 肢端肥大症患者5年生长抑素类似物初始治疗对生长激素、胰岛素样生长因子-1、肿瘤缩小以及心血管疾病的影响：一项前瞻性研究 |
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| Effects of Initial Therapy for Five Years with Somatostatin Analogs for Acromegaly on Growth Hormone and Insulin-Like Growth Factor-I Levels, Tumor Shrinkage, and Cardiovascular Disease: A Prospective Study |
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| Colao A, Auriemma RS, Galdiero M 2010/6/22 11:48:00 |
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| J Clin Endocrinol Metab, 2009, |
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| View at Publisher |
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Objective:
The objective of the study was to evaluate the efficacy of 5yr of depot somatostatin analogs (SSAs) as first-line therapy in acromegaly.
Outcome Measures:
Primary measures were fasting GH 2.5μg/liter or less and IGF-I normalized for age and tumor shrinkage. Secondary measures were control of hypertension, arrhythmias, left ventricular hypertrophy, diastolic and systolic dysfunction, and change in lipid and glucose profile.
Patients:
Patients included 45 de novo patients (18 women and 27 men, aged 20–82yr); 28 were treated with octreotide-long-acting release and 17 with lanreotide.
Results:
GH was controlled in 100% and IGF-I levels in 97.8%, tumor shrinkage was 74.9±22.1 and 78.2±14.5%, in the octreotide-long-acting release and lanreotide groups, respectively. There was a significant improvement in the prevalence of hypertension (from 46.7 to 22.2%, P=0.027), arrhythmias (from 17.8% to zero, P=0.01), left ventricular hypertrophy (from 82.2 to 42.2%, P<0.0001), diastolic dysfunction (from 60.0 to 15.6%, P<0.0001), systolic dysfunction (from 40.0 to 4.4%, P<0.0001), and hypertriglyceridemia (from 40.0 to 4.4%, P<0.0001). The prevalence of impaired glucose tolerance (IGT; from 28.9 to 20.0%. P=0.46) and diabetes mellitus (from 22.4 to 31.1%, P=0.64) did not change.
Conclusions:
In patients with severe comorbidities and those who refuse surgery, 5yr of exclusive SSA therapy induce successful control of GH and IGF-I; tumor shrinkage (by median 80%), and improvement of hypertension, cardiac performance; and dyslipidemia. No patient was withdrawn from treatment because of side effects, and glucose tolerance was stable. We suggest that first-line SSA treatment may be safely continued in patients with acromegaly, according to an individual patient's indications and preferences.
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 疾病资源中心
病例分析 [栏目介绍]
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
医学数据库
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