肢端肥大症患者治疗前后心脏结构和功能的变化  

Changes of cardiac structure and function in patients with acromegaly before and after treatment

作　　者：刘洪宇[1] 李征[1] 郭莹[1] 梁丹[1] 王尧[1] 徐剑[1] 钟历勇[1] Liu Hongyu;Li Zheng;Guo Ying;Liang Dan;Wang Yao;Xu Jian;Zhong Liyong(Department of Endocrinology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院内分泌科,100070

出　　处：《国际内分泌代谢杂志》2021年第4期318-322,共5页International Journal of Endocrinology and Metabolism

摘　　要：目的观察肢端肥大症患者手术和(或)伽马刀、长效奥曲肽治疗前后心脏结构及功能变化。方法回顾性分析2016年1月至2019年10月在北京天坛医院诊断和治疗的62例肢端肥大症患者的一般临床资料和超声心动图检查结果,根据生长激素(GH)和胰岛素样生长因子-1(IGF-1)控制水平将治疗后患者分为病情控制组和未控制组,评估治疗前后心脏结构和功能变化。结果与治疗前相比,治疗后GH和IGF-1水平显著下降,30例患者达到临床完全缓解。超声心动图可见,治疗后患者室间隔厚度(IVST)、左心室舒张末期内径(LVIDd)、左心室后壁厚度(LVPWT)降低,二尖瓣口血流频谱峰值血流速度比值(E/A)显著升高(P均<0.05);而右心室前后径(RVLD)和射血分数(EF)差异无统计学意义。进一步将治疗后患者分为GH控制组和未控制组,GH控制组治疗后RVLD显著下降、E/A显著升高(P均<0.05),而未控制组RVLD和E/A差异无统计学意义。结论肢端肥大症患者经治疗后心脏肥大明显改善,GH控制达标可提高E/A比值,有助于改善心脏舒张功能。Objective To observe the changes of cardiac structure and function in acromegalic patients before and after operation,gamma knife and long-acting octreotide therapy.Methods A total of 62 acromegalic patients were enrolled at Beijing Tiantan Hospital between January 2016 and October 2019.The patients'serum hormone and general clinical data were analyzed retrospectively.All of them received echocardiography examination.According to the growth hormone(GH)and the insulin-like growth factor-1(IGF-1)level,the patients were divided into two groups:control group and uncontrolled group.The differences of cardiac structure and function between the two groups before and after treatment were evaluated.Results After operation,and/or gamma knife and/or octreotide therapy,the GH and IGF-1 level were significantly decreased;30 of 62 patients achieved clinically complete remission.Patients'ventricular septal thickness(IVST),left ventricular diastolic diameter(LVIDd)and left ventricular posterior wall thickness(LVPWT)were decreased,while E/A was increased(all P<0.05);No significant difference was found in RVLD and EF.Further analysis found significantly decreased RVLD and increased E/A after treatment(all P<0.05)in GH control group instead of GH uncontrol group.Conclusion Patients with acromegaly have a significant improvement in cardiac hypertrophy after treatment.And GH control can improve E/A ratio and diastolic function.

关 键 词：肢端肥大症 生长激素 胰岛素样生长因子-1 心脏 

分 类 号：R584.11[医药卫生—内分泌]