成人腺垂体功能减退症合并代谢综合征患者的临床特征及其影响因素  

Clinical features and risk factors of metabolic syndrome in adult hypopituitary patients

作　　者：李婷 孙丽思 王椿[1] 李建薇 安振梅[1] 余叶蓉[1] Li Ting;Sun Lisi;Wang Chun;Li Jianwei;An Zhenmei;Yu Yerong(Department of Endocrinology and Metabolism,West China Hospital,Sichuan University,Chengdu,610041,China;Department of Radiation Oncology,Chongqing University Cancer Hospital,Chongqing 400030,China)

机构地区：[1]四川大学华西医院内分泌与代谢科,成都610041 [2]重庆大学附属肿瘤医院放射肿瘤科,重庆400030

出　　处：《中华医学杂志》2021年第36期2885-2892,共8页National Medical Journal of China

摘　　要：目的探讨成人腺垂体功能减退症(HP)合并代谢综合征(MS)患者的临床特征及其影响因素。方法收集2012年1月至2019年12月在华西医院内分泌科门诊或住院部确诊为HP患者(HP组)的临床资料,因鞍区病变就诊但腺垂体功能正常者作为对照组,HP组依据是否合并MS分为MS组和Non‑MS组,根据生长激素(GH)水平将HP组分为GH>0.35μg/L、0.13μg/L<GH≤0.35μg/L、0.05μg/L<GH≤0.13μg/L和GH≤0.05μg/L组,比较临床特征的组间差异。结果共纳入患者HP组264例(男163例,51.5%),对照组53例(男22例,41.5%)。两组年龄[(41±13)比(40±12)岁]及体质指数[(23.3±4.5)比(23.1±3.9)kg/m^(2)]差异均无统计学意义(均P>0.05)。HP组普遍存在诊治时间延误现象,接受规范替代治疗者不足50%。HP组的MS患病率(39.4%比24.4%)、腰围[(87.2±10.6)比(82.2±12.6)cm]、三酰甘油[M(Q_(1),Q_(3))为1.81(1.15,2.83)比1.14(0.80,1.69)mmol/L]、非酒精性脂肪性肝病患病率(30.9%比12.5%)均高于对照组(均P<0.05);HP组的血压[收缩压:(112±19)比(124±16)mmHg;舒张压:(70±12)比(81±12)mmHg,1 mmHg=0.133 kPa]、高密度脂蛋白胆固醇[1.06(0.83,1.35)比1.49(1.14,1.78)mmol/L]均低于对照组(均P<0.05)。MS组GH[0.11(0.03,0.35)比0.20(0.05,0.41)μg/L]及胰岛素样生长因子‑1[58.33(38.12,76.03)比65.54(51.78,101.76)μg/L]水平均低于Non‑MS组(均P<0.05)。HP患者GH水平越低(GH>0.35μg/L、0.13μg/L<GH≤0.35μg/L、0.05μg/L<GH≤0.13μg/L以及GH≤0.05μg/L),其MS患病率(25.5%、30.0%、42.9%、48.6%)越高(P=0.031)。结论成人HP患者MS患病率高于腺垂体功能正常者,腹型肥胖及血脂异常是其MS的主要组分,GH缺乏与HP患者发生MS密切相关。Objective To investigate the clinical features and risk factors of metabolic syndrome(MS)in adult hypopituitary patients(HP).Methods Patients diagnosed with HP in the outpatient or inpatient department of the endocrinology department in West China Hospital from January,2012 to December,2019 were selected as the experimental group(HP group),and patients with normal pituitary function treated for saddle lesions were selected as the control group.HP patients with or without MS were divided into MS group and non-MS group HP patients were divided into four groups according to the level of growth hormone by the quartile method(GH>0.35μg/L、0.13μg/L<GH≤0.35μg/L、0.05μg/L<GH≤0.13μg/L and GH≤0.05μg/L).And then we compared the differences in clinical characteristics between groups.Results A total of 264 patients with HP(136 males,51.5%)and 53 patients with normal pituitary function(22 males,41.5%)were included.There were no significant differences between the two groups in age[(41±13)vs(40±12)years old]and body mass index(BMI)[(23.3±4.5)vs(23.1±3.9)kg/m^(2)].Delays in diagnosis and treatment were common in HP,and less than 50%of HP patients received standard alternative therapy.The prevalence of MS(39.4%vs 24.4%)and non-alcoholic fatty liver disease(30.9%vs 12.5%),waist circumference[(87.2±10.6)vs(82.2±12.6)cm],triglyceride[M(Q_(1),Q_(3))为1.81(1.15,2.83)vs 1.14(0.80,1.69)mmol/L]in HP group were higher than those in control group(P<0.05).Blood pressure[systolic blood pressure:(112±19)vs(124±16)mmHg;diastolic blood pressure:(70±12)vs(81±12)mmHg;1 mmHg=0.133 kPa]and HDL cholesterol[1.06(0.83,1.35)vs 1.49(1.14,1.78)mmol/L]in HP group were lower than those in control group(P<0.05).The levels of GH[0.11(0.03,0.35)vs 0.20(0.05,0.41)μg/L]and IGF-1[58.33(38.12,76.03)vs 65.54(51.78,101.76)μg/L]in MS group were lower than those in non‐MS group(P<0.05).The lower the GH level(GH>0.35μg/L、0.13μg/L<GH≤0.35μg/L、0.05μg/L<GH≤0.13μg/L and GH≤0.05μg/L)in patients with HP,the higher the prevalence

关 键 词：垂体功能减退症 代谢综合征 生长激素缺乏 

分 类 号：R589[医药卫生—内分泌] R584.2[医药卫生—内科学]