奥曲肽敏感试验预测长效生长抑素受体配体治疗垂体GH腺瘤的疗效  

Value of octreotide suppression test in predicting the efficacy of long-acting somatostatin receptor ligands in pituitary GH adenomas

作　　者：李冉[1] 段炼[1] 潘慧[1] 杨盛旻 王林杰[1] 阳洪波[1] 龚凤英[1] 柯晓安 陈美平 朱惠娟[1] Li Ran;Duan Lian;Pan Hui;Yang Shengmin;Wang Linjie;Yang Hongbo;Gong Fengying;Ke Xiaoan;Chen Meiping;Zhu Huijuan(Department of Endocrinology,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]北京协和医院内分泌科,100730

出　　处：《中华内分泌代谢杂志》2022年第4期288-293,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探究奥曲肽敏感试验预测生长抑素受体配体(somatostatin receptor ligands,SRLs)治疗活动性肢端肥大症的临床应用价值。方法回顾性分析2011年至2020年间76例未接受过放射治疗的活动性肢端肥大症患者的临床资料,所有患者均在晨起空腹状态下皮下注射短效奥曲肽100μg,分别在0、2、4、6和8 h采血测定血清生长激素(GH)水平,所有患者均接受SRLs治疗至少3个月。SRLs治疗有效的标准为:治疗后血清随机GH<1μg/L或GH较基线值下降>80%定义为GH有效;治疗后血清胰岛素样生长因子Ⅰ(IGF-Ⅰ)<1.3倍参考范围上限(upper limit of normal,ULN)或IGF-Ⅰ较基线值下降>50%定义为IGF-Ⅰ有效;同时满足GH和IGF-Ⅰ有效的标准定义为GH和IGF-Ⅰ均有效。结果奥曲肽敏感试验中基线GH为15.00(6.38,34.20)μg/L,血清GH达到谷值的时间为(3.65±1.65)h,GH谷值为1.47(0.50,4.19)μg/L,GH抑制率为89.12%(72.71%,95.09%)。奥曲肽敏感试验中GH抑制率为89.32%时,曲线下面积(AUC)为0.74,预测GH有效的敏感度为81.80%,特异度为66.00%;GH抑制率为93.14%时,AUC为0.64,预测IGF-Ⅰ有效的敏感度和特异度分别为50.00%、75.60%;GH抑制率为90.71%时,AUC为0.78,预测GH和IGF-Ⅰ同时有效的敏感度为83.30%,特异度为70.00%。GH/IGF-Ⅰ有效组较GH/IGF-Ⅰ无效组奥曲肽敏感试验中GH谷值更低、GH抑制率更高、IGF-Ⅰ下降率更高、治疗后IGF-Ⅰ/ULN比值更低(P<0.05)。结论奥曲肽敏感试验中GH抑制率可以用来预测SRLs治疗垂体GH腺瘤的疗效,诊断界值为90.71%时敏感度和特异度最高。Objective To explore the value of octreotide suppression test(OST)in predicting the efficacy of somatostatin receptor ligands(SRLs)in the treatment of active acromegaly.Methods The clinical data of 76 patients with active acromegaly from 2011 to 2020 was retrospectively analyzed.OST was carried out as follows:After an overnight fasting and baseline sampling of growth hormone(GH),100μg octreotide was subcutaneously injected,and sampling for GH was obtained every 2 hours for 8 hours.All patients were treated with SRLs for at least 3 months.A good GH response is defined as a post-treatment random GH<1μg/L or>80%fall compared with the baseline GH.A good insulin-like growth factorⅠ(IGF-Ⅰ)response is defined as IGF-Ⅰ<1.3 upper limit of normal(ULN)or>50%reduction compared with the baseline.If both GH and IGF-Ⅰfulfill the criteria of a good response,it is defined as a good GH and IGF-Ⅰresponse.Results The baseline level of GH during OST was 15.00(6.38,34.20)μg/L,the median time to reach the nadir GH was(3.65±1.65)hours,and the nadir GH level was 1.47(0.50,4.19)μg/L.The median GH suppression rate was 89.12%(72.71%,95.09%).When the cutoff value of GH suppression rate in predicting a good GH response was 89.32%,the area under the curve(AUC)was 0.74,with a sensitivity of 81.80%and specificity of 66.00%.When the cutoff value of GH suppression rate in predicting a good IGF-Ⅰresponse was 93.14%,the AUC was 0.64,with a sensitivity of 50.00%and specificity of 75.60%.When the GH suppression rate was 90.71%,the AUC was 0.78,with the sensitivity of 83.30%and specificity of 70.00%in predicting a good GH and IGF-Ⅰresponse.Compared with GH/IGF-Ⅰnon-responders,GH/IGF-Ⅰresponders displayed lower nadir GH during OST,higher GH suppression rate and IGF-Ⅰreduction rate,and lower ratio of IGF-1 to ULN(P<0.05).Conclusion GH suppression rate during the OST is a valuable predictor to evaluate the efficacy of SRLs in patients with acromegaly,with the highest sensitivity and specificity when the cutoff value is 90.71%.

关 键 词：奥曲肽敏感试验 长效生长抑素受体配体 肢端肥大症 生长激素抑制率 

分 类 号：R736.4[医药卫生—肿瘤]