长效奥曲肽治疗垂体生长激素瘤手术或伽马刀治疗后未缓解的肢端肥大症患者的临床研究  

Clinical study on the effectiveness of long-acting octreotide in acromegaly patients after surgery or gamma knife therapy of growth hormone-secreting pituitary adenoma

作　　者：王芳[1] 钟历勇[1] 

机构地区：[1]首都医科大学附属北京天坛医院内分泌科,100050

出　　处：《中国医师进修杂志》2017年第11期982-985,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 观察垂体生长激素瘤手术或伽马刀治疗后未缓解的肢端肥大症患者使用长效奥曲肽治疗的效果.方法 收集规律使用长效奥曲肽治疗的垂体生长激素瘤患者6例,其中5例为经蝶垂体瘤术后,1例为伽马刀治疗后.患者均每个月住院评估病情及垂体-各靶腺轴功能并行奥曲肽治疗,回顾性分析治疗6个月的临床资料.结果 6例患者奥曲肽治疗后临床症状较前缓解,2例生化控制达标;2例空腹生长激素水平〈2.5μg/L,但胰岛素样生长因子-1（IGF-1）水平仍较高;2例生长激素和IGF-1水平虽较治疗前下降,但均高于正常.6例患者治疗后IGF-1水平较治疗前明显下降[（371.83±217.46）μg/L比（713.33±198.29）μg/L],差异有统计学意义（P=0.017）.奥曲肽治疗前后糖化血红蛋白和空腹血糖比较差异无统计学意义（P〉0.05）.结论 垂体生长激素瘤手术或伽马刀治疗后未缓解的肢端肥大症患者,长效奥曲肽可有效控制IGF-1水平,增加疾病生化控制达标率.Objective To observe the effectiveness of long-acting octreotide in the treatment of acromegaly patients who did not achieve biochemical control after neurosurgery or gamma knife therapy of growth hormone-secreting pituitary adenoma. Methods Six acromegaly patients who received long-acting octreotide treatment regularly were included. Five patients had received prior trans-sphenoidal surgery and 1 patient had received prior gamma knife therapy before admission. All patients were admitted monthly for evaluation of pituitary-target gland function and octreotide therapy. Data of treatment with octreotide for 6 months were retrospectively summarized. Results Symptoms were reported to be alleviated. Two patients achieved biochemical control of the disease. Two patients had fasting growth hormone level less than 2.5 μg/L,but insulin-like growth factor-1（IGF-1）level was still higher than the age-adjusted normal range.Another 2 patients had decreased growth hormone and IGF-1 level, but both still higher than the normal range. Compared with baseline, IGF-1 level was decreased after treatment：（371.83 ± 217.46）μg/L vs.（713.33 ± 198.29）μg/L,and there was statistical difference （P = 0.017）. There were no statistical differences in glycated hemoglobin and fasting plasma glucose before and after octreotide treatment （P 〉 0.05）. Conclusions For acromegaly patients who do not achieve biochemical control after neurosurgery or gamma knife therapy, long-acting octreotide can effectively control IGF-1 level and increase the biochemical control rate of the disease.

关 键 词：肢端肥大症 分泌生长激素的脑垂体腺瘤 奥曲肽 胰岛素样生长因子Ⅰ 

分 类 号：R584.11[医药卫生—内分泌] R736.4[医药卫生—内科学]