垂体生长激素瘤合并甲状腺异常的疾病谱及相关危险因素分析  

Spectrum and risk factors of growth hormone-secreting pituitary tumor combined with thyroid diseases

作　　者：洪翩 沈如飞 张磊 李行 彭桂亮 周玲 张玉玲 廖明钰 李蔚鑫 隆敏 郑宏庭 Hong Pian;Shen Ru-Fei;Zhang Lei;Li Xing;Peng Gui-Liang;Zhou Ling;Zhang Yu-Ling;Liao Ming-Yu;Li Wei-Xin;Long Min;Zheng Hong-Ting(Department of Endocrinology,the Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院内分泌科,重庆400037

出　　处：《解放军医学杂志》2022年第3期251-257,共7页Medical Journal of Chinese People's Liberation Army

基　　金：陆军军医大学临床研究项目(2018XLC3049)。

摘　　要：目的探讨垂体生长激素(GH)瘤合并甲状腺异常的疾病谱及其临床特征,并分析相关危险因素。方法回顾性分析陆军军医大学第二附属医院2015年1月-2021年3月收治的133例行甲状腺超声和功能检查的GH瘤患者的基本临床资料,根据是否合并甲状腺异常,将GH瘤患者分为甲状腺异常组与甲状腺正常组。比较两组患者的临床资料,采用多重线性回归分析变量间的相关性,并采用二元logistic回归分析GH瘤合并甲状腺疾病的危险因素。结果本组133例GH瘤患者中合并甲状腺疾病者共108例(81.2%)。(1)按影像学分类:结节性甲状腺肿大51例(38.3%),单纯甲状腺结节44例(33.1%),单纯甲状腺肿大5例(3.8%),无甲状腺超声影像学异常者33例(24.8%);(2)按甲状腺功能分类:甲状腺功能异常者34例(25.6%),甲状腺功能正常者99例(74.4%);(3)按甲状腺病理分类:10例患者完善病理检查,其中甲状腺癌2例(1.5%),良性甲状腺结节8例(6.0%),其余123例(92.5%)未行病理检查;(4)按疾病种类分类:自身免疫性甲状腺疾病22例(16.5%),甲状腺免疫学指标正常111例(83.5%)。单因素分析结果显示,GH瘤患者中甲状腺异常组GH谷值明显高于甲状腺正常组(P<0.05)。多元线性回归分析结果显示,GH瘤患者甲状腺体积与胰岛素样生长因子-1(IGF-1)、年龄、体重指数(BMI)及甲状腺球蛋白(Tg)呈正相关,而与促甲状腺激素(TSH)、甲状腺素(T_(4))呈负相关(偏回归系数分别为0.000、0.006、0.019、0.001、±0.144、±0.002,P<0.05);而甲状腺结节直径仅与Tg及年龄呈正相关(偏回归系数分别为0.004、0.017,P<0.05)。二元logistic回归分析结果显示,GH瘤患者葡萄糖抑制生长激素试验中GH谷值(简称GH谷值)增高、超重(BMI为24~26 kg/m^(2))及蝶窦侵犯评分≥2分者,合并甲状腺疾病的风险增高(P<0.05),比值比(OR)分别为11.450、5.022、6.576。结论垂体GH瘤患者各种甲状腺疾病发生率高,以结节性甲状腺肿和单�Objective To investigate the spectrum and clinical characteristics of growth hormone(GH)-secreting pituitary tumor combined with thyroid diseases and to analyze its risk factors.Methods A retrospective study was used to analyze 133 patients with GH-secreting pituitary tumor who underwent thyroid ultrasound examination in the Second Affiliated Hospital of Army Medical University.The patients with GH-secreting pituitary tumor were divided into thyroid abnormal group and normal thyroid group.The clinical data of the two groups were compared.The correlation between variables was analyzed by multiple linear regression,and the risk of GH-secreting pituitary tumor with thyroid disease was analyzed by binary logistic regression.Results Among the 133 GH-secreting pituitary tumor patients,108 cases(81.2%)had thyroid diseases.(1)Classified by thyroid ultrasonography,51(38.3%)with nodular goiters,44 cases(33.1%)with simple thyroid nodules,5 cases(3.8%)with goiters,33 cases(24.8%)without thyroid ultrasound abnormalities.(2)Classified by thyroid function,34 cases(25.6%)with thyroid dysfunction,99 cases(74.4%)with normal thyroid function.(3)Classified by pathology of thyroid,10 cases accomplished thyroid pathological examination,2 cases(1.5%)with thyroid cancers,8 cases(6.0%)with benign thyroid nodules,123 cases(92.5%)without pathological examination.(4)Classified by nosology,22 cases(16.5%)with thyroiditis,111 patients(83.5%)with normal thyroid immunological indicators.Univariate analysis showed that the nadir GH levels in patients with GH-secreting pituitary tumor was higher in the thyroid abnormality group than in the normal thyroid group(P<0.05).Multiple linear regression analysis showed that thyroid volume was positively correlated with insulin-like growth fator-1(IGF-1),age,body mass index(BMI),thyroid stimulating hormone(TSH),thyroxine(T_(4))and thyroglobulin(Tg),[partial regression coefficient(B)=0.000,0.006,0.019,0.001,±0.144,±0.002 respectively,P<0.05].The diameter of thyroid nodule was only positively correlated wi

关 键 词：垂体生长激素瘤 甲状腺疾病 甲状腺结节 相关性 

分 类 号：R736.4[医药卫生—肿瘤]