肢端肥大症合并甲状腺疾病的临床特点及相关危险因素分析  

Clinical characteristics and relevant risk factors of acromegaly combined with thyroid diseases

作　　者：高路[1] 吴遐[1] 郭晓鹏[1] 李一琳[1] 张硕[1] 汪强[1] 王子豪[1] 连伟[1] 王任直[1] 幸兵[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院神经外科,100730

出　　处：《中国微侵袭神经外科杂志》2017年第4期149-153,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨肢端肥大症合并甲状腺疾病的临床特点及相关危险因素。方法严格按照纳入及排除标准选取93例初诊初治的肢端肥大症病人,均行甲状腺超声检查,诊断标准使用TI-RADS评价系统。临床资料的相关性采用多重线性回归分析,危险因素分析采用二分类Logistic回归。结果 72例(77.4%)合并甲状腺疾病设为甲状腺异常组,其中良性69例,恶性3例;余21例设为甲状腺正常组。多重线性回归分析表明:甲状腺体积与生长激素随机值(P=0.002)、生长激素谷值(P=0.005)及胰岛素样生长因子1(IGF-1)值(P=0.004)均呈线性相关;T3水平与IGF-1值呈正相关关系(P<0.05)。甲状腺异常组比甲状腺正常组具有更高的GH负荷水平(P<0.05)。多因素Logistic回归分析表明:年龄是肢端肥大症病人合并甲状腺疾病的独立危险因素(P=0.002)。结论与正常人群相比,肢端肥大症病人合并甲状腺良、恶性疾病的风险均显著提高,且年龄是其独立危险因素;甲状腺体积、功能与异常升高的生长激素、IGF-1密切相关。临床医师应做好肢端肥大症合并症的早期评估和规范化诊疗,重视术后的内分泌学治愈。Objective To explore the clinical characteristics and risk factors of acromegaly combined with thyroid diseases. Methods Ninety-three patients newly diagnosed with acromegaly were recruited according to the inclusion and exclusion criteria. All the patients underwent thyroid ultrasonography and were diagnosed with TI-RADS evaluation system. Multivariate linear regression analysis was used to detect the correlations between clinical data. Binary logistic regression analysis was used to identify risk factors. Results Seventy-two acromegalic patients （77.4%） complicated with thyroid diseases including 69 benign and 3 malignant were set as thyroid-disease group, and remaining 21 patients with normal thyroid were set as normal thyroid group. Multiple linear regression analysis showed that volume of thyroid was linearly correlated with growth hormone （GH） random value （P = 0.002）, growth hormone nadir value （P = 0.005） and insulirdike growth factor （IGF-1） value （P = 0.004）. T3 level was linearly correlated with IGF-1 value （P 〈 0.05）. Thyroid-disease group had higher GH load than normal thyroid group （P 〈 0.05）. Multivariate logistic regression analysis showed that age was an independent risk factor for aeromegaly combined with thyroid diseases （P = 0.002）. Conclusions Compared with the normal population, the risk for benign or malignant thyroid disease is significantly higher in acromegaly and age is an independent risk factor. The volume and fianction of thyroid are closely related to abnormally elevated growth hormone and IGF-1. Clinical doctors should make the early assessment and standardized diagnosis and treatment of concomitant diseases of acromegaly and pay more attention to the endocrinological recovery after surgery.

关 键 词：肢端肥大症 垂体肿瘤 生长激素 甲状腺疾病 

分 类 号：R581[医药卫生—内分泌] R584.11[医药卫生—内科学]