促肾上腺皮质激素瘤患者高血糖的患病情况及其术后改变  

Hyperglycemia in patients with ACTH-secreting pituitary adenoma and changes after operation

作　　者：张炜[1] 王毛毛 张英[1] 杜娟[1] 王春梅 张征[1] 刘宏亮[2] ZHANG Wei;WANG Maomao;ZHANG Ying(Department of Endocrinology,Renhe Hospital Affiliated to Shanghai University,Shanghai 200431 China)

机构地区：[1]上海大学附属仁和医院内分泌科,200431 [2]上海大学附属仁和医院神经外科,200431 [3]海军军医大学附属长海医院神经外科

出　　处：《中国糖尿病杂志》2022年第6期443-447,共5页Chinese Journal of Diabetes

基　　金：上海市宝山区仁和医院中青年优秀人才培养计划资助(BSRHYX-2020-04)。

摘　　要：目的 评价促肾上腺皮质激素(ACTH)瘤患者高血糖的患病情况及其术后改变。方法 选取2010年1月至2020年12月于海军军医大学附属长海医院神经外科、上海大学附属仁和医院神经外科住院诊治的ACTH瘤患者45例(ACTH组),另选取同期于仁和医院就诊的垂体无功能瘤患者31例(NPA组),于仁和医院体检健康者53名为正常对照(NC)组。检测各组血和尿皮质醇、ACTH,并行75 g OGTT,计算胰岛素抵抗指数(HOMA-IR)、血糖及Ins受试者工作特征曲线下面积(AUCGlu,AUCIns)。ACTH组行垂体手术治疗后对激素及糖代谢相关生化检查结果并与术前结果比较。结果 ACTH组SBP、FIns、2 hPG、2 hIns、AUCGlu、AUCIns、HOMA-IR、8:00血皮质醇、24:00血皮质醇、24 h尿游离皮质醇、8:00血ACTH高于NC、NPA组(P<0.05)。ACTH组伴高血糖亚组FPG、2 hPG、AUCGlu、8:00、24:00血皮质醇及尿皮质醇高于不伴高血糖亚组(P<0.05)。术后FIns、2 hIns、AUCGlu、AUCIns、HOMA-IR、8:00血皮质醇、24:00血皮质醇、尿皮质醇及8:00血ACTH低于术前(P<0.05)。Pearson相关分析显示,ACTH瘤患者8:00血皮质醇与2 hPG及AUCGlu呈正相关(P<0.05),尿游离皮质醇与FPG、2 hPG及AUCGlu呈正相关(P<0.05)。结论 ACTH瘤患者高血糖患病率升高,其原因与激素高分泌相关。手术摘除肿瘤,激素高分泌状态解除后,患者高血糖情况改善。Objective To describe the features of hyperglycemia in patients with ACTH-secreting pituitary adenoma and the changes after pituitary operation.Methods Forty-five patients with ACTH secreting pituitary adenoma were evaluated. Plasma and urinary cortisol,plasma adrenocorticotropic hormone(ACTH) were measured. Oral glucose tolerance test(OGTT) was performed and calculate insulin resistance homeostasis(HOMA-IR),area under the AUC curve of glucose(AUCGlu)and insulin(AUCIns).31 patients with nonfunctional pituitary adenoma(NPA)and 53 healthy people were set as controls.ResultsSBP,FIns,2 hPG,2 hIns,AUCGlu,AUCIns,HOMA-IR,8:00 plasma cortisol,24:00 plasma cortisol,24-hour urine free cortisol and 8:00 plasma ACTH in pituitary adenoma group were higher than those in NC and NPA groups(P<0. 05). The levels of FPG,2 h PG,AUCGlu,blood cortisol and urine cortisol in patients with hyperglycemia were higher than those in patients without hyperglycemia(P<0. 05).FIns,2 hIns,AUCGlu,AUCIns,HOMA-IR,8:00 blood cortisol,24:00 blood cortisol,urine cortisol and 8:00blood ACTH after operation were lower than those before operation(P<0. 05). Pearson correlation analysis showed that the serum cortisol at 8:00 was positively correlated with 2 h PG and AUCGlu(P<0. 05).Urinary cortisol was positively correlated with FPG,2 hPG and AUCGlu(P<0. 05).Conclusion Patients with ACTH-secreting pituitary adenoma have higher prevalence of hyperglycemia,which is related with over secretion of hormone. The hyperglycemic status improved after surgical removal of the tumor.

关 键 词：促肾上腺皮质激素瘤 皮质醇 高血糖 糖尿病 

分 类 号：R736.6[医药卫生—肿瘤]