摘要
目的探讨经蝶入路垂体腺瘤切除术对垂体生长激素(GH)腺瘤糖耐量状态的影响。方法回顾性分析2013年在北京协和医院神经外科就诊的105例垂体GH腺瘤的临床资料,比较手术前后患者的糖耐量状态、GH和胰岛素样生长因子-1(IGF-1)水平,评估手术对不同糖耐量状态的疗效。结果 105例患者中,47例(44.8%)术前为正常血糖(NGT),26例(24.8%)为糖尿病前期(ECMDs),32例(30.5%)为糖尿病(DM)。除NGT组外,ECMDs和DM组的术后空腹血糖(P=0.006,P=0.017)和餐后血糖(P=0.000,P=0.000)都得到明显改善;NGT组、ECMDs组和DM组患者的术后随机GH水平(P=0.001,P=0.004,P=0.001)、GH谷值(P=0.000,P=0.001,P=0.001)及IGF-1水平(P=0.005,P=0.000,P=0.000)均较术前均显著下降;DM组的空腹血糖(P=0.029,P=0.000)、餐后血糖(P=0.003,P=0.000)及血清IGF-1水平下降幅度(P=0.048,P=0.000)均明显大于ECMDs组和NGT组。结论经蝶垂体腺瘤切除术可明显改善垂体GH腺瘤患者的血糖、GH及IGF-1水平,且手术对术前明确DM者的糖耐量状态及IGF-1水平改善较ECMDs更显著。
Objective To explore the effect of transsphenoidal adenectomy on glucose tolerance status in patients with growth hormone（ GH）-secreting pituitary adenoma. Methods The clinical data of 105 patients with GH-secreting pituitary adenoma who underwent transsphenoidal adenectomy in our department in 2013 were retrospectively analyzed. The glucose tolerance status,GH level,and insulin-like growth factor-1（ IGF-1）level before and after surgery were compared. Results Among these 105 patients,the blood glucose tolerance status included normal glucose tolerance（ NGT） in 47 cases（ 44. 8%）,early carbohydrate metabolism disorders（ ECMDs） in 26 cases（ 24. 8%）,and diabetes mellitus（ DM） in 32 cases（ 30. 5%） before surgery.After the surgery,the fasting blood glucose（ P = 0. 006,P = 0. 017） and postprandial blood glucose（ P =0. 000,P = 0. 000） in the ECMDs and DM groups were significantly improved. Also,the random GH（ P =0. 001,P = 0. 004,P = 0. 001）,nadir GH（ P = 0. 000,P = 0. 001,P = 0. 001）,and IGF-1（ P = 0. 005,P = 0. 000,P = 0. 000） significantly decreased during the follow-up period in NGT,ECMDs and DM groups.Compared with ECMDs and DM groups,the decrease in fasting blood glucose（ P = 0. 029,P = 0. 000）,postprandial blood glucose（ P = 0. 003,P = 0. 000）,and serum IGF-1（ P = 0. 048,P = 0. 000） were more significant in DM group. Conclusions Transsphenoidal adenectomy can improve the blood glucose, GH, and IGF-1 levels in patients with growth hormone-secreting pituitary adenoma. Meanwhile,the surgery has a better effect in improving the glucose tolerance status and IGF-1 in patients with preoperatively confirmed DM.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2016年第1期73-77,共5页
Acta Academiae Medicinae Sinicae
关键词
垂体生长激素腺瘤
胰岛素样生长因子-1
糖耐量
经蝶手术
growth hormone-secreting pituitary adenoma
insulin-like growth factor-1
glucose tolerance
transsphenoidal surgery
