垂体生长激素分泌瘤患者糖代谢异常及治疗后的转归——附214例病例分析

目的探讨垂体生长激素分泌瘤（垂体GH瘤）患者糖代谢异常的发生率以及治疗后的转归。方法分析1999-2008年在本院就诊的214例垂体GH瘤患者糖代谢异常情况以及治疗后的转归。结果垂体GH瘤患者治疗前糖代谢异常117例（54．7％），其中IFG、IGT以及DM分别为13例（6．1％）、32例（15．0％）和72例（33．6％）。治疗后治愈（GH谷值≤1ng／m1）的35例DM患者中有14例（40％）转为NGT，未治愈的37例DM患者中有7例（18．9％）转为NGT，两组比较差异有统计学意义（P〈0．01）。未治愈的63例NGT患者中治疗后11例转为糖耐量异常。经多元回归分析，垂体GH瘤发病年龄及病程是发生DM的危险因素；治疗后DM的转归与垂体GH瘤治疗后GH是否降至正常和病程显著相关（P〈0．01），与性别、年龄、血压、治疗前GH水平及肿瘤大小未见明显相关。结论垂体GH瘤患者可出现不同程度的糖耐量异常。治疗后，GH完全恢复正常的患者，多数糖耐量异常的情况可明显改善或治愈。病程越长，垂体GH瘤患者糖耐量异常越难恢复正常。

Abnormality of glucose metabolism and therapeutic outcomes in patients with pituitary growth hormone-secreting adenoma: Analysis of 214 cases

Objective To investigate the prevalence of abnormality of glucose metabolism and therapeutic outcomes in patients with pituitary growth hormone （GH）-secreting adenoma. Methods We retrospectively analyzed the prevalence of abnormality in glucose metabolism and therapeutic outcomes in 214 patients with pituitary GH-secreting adenoma, who were diagnosed and treated in Peking Union Medical College Hospital between 1999 and 2008. Results In 214 patients with GH-secreting adenoma, there were 119 males and 95 females. The average onset age was 37.3 ± 11.2 years. The average duration was 6.1±5.0 years. Before treatment, according to OGTT, 117 （54.7%） patients were abnormal in glucose metabolism, including 13 （ 6.1 %） patients with impaired fasting glucose （IFG）, 32 （ 15.0 %） patients with impaired glucose tolerance （IGT） and 72 （33.6%） patients with diabetes mellitus （DM）. After treatment, in the group of cured patients（GH≤1ng/ml,after OGTT）, 14 （40%） patients turned to normal glucose tolerance （NGT） in 35 patients with previously diagnosed diabetes, while in the group of uncured patients only 7 （18.9 %, 7/37） DM patients changed to NGT. By multi-factorial logistic analysis, the onset age and duration were risk factors for DM onset in pituitary GH-secreting adenoma. After treatment, the outcomes of DM had remarkable relationship with cured GH levels and shorter duration （all P〈0.01）, and had no relationship with sex, age, BP, GH level before treatment and the size of tumors （all P〉0. 05）. Conclusions In the patients with pituitary GH-secreting adenoma, the prevalence of abnormal glucose metabolism is much higher than in normal population. In patients with GH decrement to normal level, most of abnormal glucose metabolism can be improved or even cured after treatment. The longer the duration,the less reversible the glucose abnormality in pituitary GH-secreting adenoma patients.