GH/IGF-1不一致的肢端肥大症患者临床特征分析及GH不同切点对不一致率的影响  

Discordant GH and IGF-1 levels in acromegaly:Analysis of clinical characteristics and impact of GH cut-offs on discordance rate

作　　者：崇立业 刘梦思 张子为[1] 杨帆[1] 朱大龙[1] 李平[1] Chong Liye;Liu Mengsi;Zhang Ziwei;Yang Fan;Zhu Dalong;Li Ping(Department of Endocrinology,Endocrine and Metabolic Disease Medical Center,Nanjing Drum Tower Hospital,Afiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China;Department of Endocrinology,Endocrine and Metabolic Disease Medical Center,Nanjing Drum Tower Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院内分泌科,南京210008 [2]中国医学科学院北京协和医学院南京鼓楼医院内分泌科,南京210008

出　　处：《中华内分泌代谢杂志》2024年第11期941-947,共7页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探究仅生长激素(GH)或胰岛素样生长因子-1(IGF-1)升高(即GH/IGF-1不一致)的肢端肥大症患者的临床特征, 分析GH不同切点对GH/IGF-1不一致率的影响。方法纳入南京鼓楼医院内分泌科2017年11月至2023年3月随访资料完整的肢端肥大症患者66例。根据末次随访时GH谷值(GHn)和IGF-1水平, 将患者分为缓解组、高GH组、高IGF-1组、活动组, 比较各组临床及代谢指标的差异。探究不同GHn和空腹GH(GHf)切点对GH/IGF-1不一致率的影响。结果 4组在年龄、随访时间、影像学方面差异无统计学意义(均P>0.05)。高IGF-1组空腹胰岛素、胰岛β细胞功能指数均高于缓解组和高GH组(均P<0.05), 而上述指标在高GH组和缓解组间差异无统计学意义。高IGF-1组血清1型胶原交联羧基端肽、骨钙素及血清1型原胶原氨基端前肽水平高于缓解组及高GH组, 但差异无统计学意义(均P>0.05);高GH组骨代谢指标与缓解组相比差异亦无统计学意义。对于GHn, 以1.0 μg/L和0.4 μg/L为切点, GH/IGF-1不一致率差异无统计学意义(30.3%对21.3%,P=0.146)。与2.5 μg/L相比, GHf切点为1.0 μg/L时GH/IGF-1不一致率更低(39.4%对24.3%,P=0.041)。结论治疗后随访的肢端肥大症患者GH/IGF-1不一致率约为30%, 不同GH测定时机及切点影响GH/IGF-1不一致率。仅IGF-1升高患者可能存在疾病活动风险, 有必要加强随访。本研究为GH/IGF-1不一致的肢端肥大症患者治疗决策提供了参考。Objective To analyze clinical characteristics of acromegaly patients who have discordant growth hormone(GH)or insulin-like growth factor-1(ICF-1)levels and evaluate impact of different GH cut-offs on discordance rate.Methods A retrospective analysis was conducted on data from 66 acromegaly patients treated at Nanjing Drum Tower Hospital from November 2017 to March 2023.Patients were categorized based on the nadir GH(CHn)and ICF-1 levels at the last follow-up into four groups:controlled,high GH,high ICF-1,and active.Clinical and metabolic parameters were compared across these groups,and impact of different GHn and fasting growth hormone(GHf)cut-offs on discordance rate was evaluated.Results No statistically significant differences were observed among groups in age,duration of follow-up,imaging characteristics(all P>0.05).High ICF-1 group had higher fasting insulin and homeostasis model assessment forβcell function compared to controlled and high GH group(all P<0.05),while these parameters did not differ between high GH and controlled group.High IGF-1 group had higher carboxy-terminal cross-linked telopeptide of type 1 collagen,osteocalcin and procollagen type 1 N-terminal propeptide compared to controlled and high GH group,but differences were not statistically significant(all P>0.05).These parameters also did not differ between high GH and controlled group.Discordance rate was not significantly different when GHn cut-offs was 1.0μg/L or 0.4μg/L(30.3%us 21.3%,P=0.146).Compared to 2.5μg/L,discordance rate was lower when GHf cut-off was 1.0μg/L(39.4%us 24.3%,P=0.041).Conclusion The discordance rate in treated acromegaly patients during follow-up is approximately 30%.Different GH measurement timings and cut-offs significantly impact discordance rate.Patients with normal GH and elevated IGF-1 levels are at potential risk of active disease,and require closer follow-up.This study provides a valuable reference for treatment of patients with discordant CH and ICF-1 levels.

关 键 词：肢端肥大症 GH/IGF-1不一致 GH切点 糖代谢 骨代谢 

分 类 号：R584.11[医药卫生—内分泌]