长效生长抑素类似物联合手术治疗肢端肥大症疗效分析

目的评价初始长效生长抑素类似物联合手术治疗肢端肥大症的临床疗效。方法回顾性分析2005—2008年在北京协和医院内分泌科收治并定期随访的初始长效生长抑素类似物(SSA)治疗联合经蝶手术切除垂体腺瘤并经病理证实的23例肢端肥大症患者病历资料。结果肢端肥大症患者长效SSA治疗(≥3个月)后生长激素(GH)谷值明显降低(P<0.01),肿瘤体积缩小(P=0.012)。术前生化控制组(GH<0.047 nmol/L)较未控制组(GH≥0.047 nmol/L)肿瘤体积小(P=0.015),术后初次(P=0.002)及末次随访(P=0.018)GH谷值低。结论肢端肥大症患者术前应用长效SSA治疗可降低术前GH水平、缩小肿瘤体积,是提高手术疗效的原因之一;术前口服葡萄糖耐量试验GH谷值可用于评价肢端肥大症患者的手术预后。

Efficacy of somatostatin analogues in combination with surgery in patients with acromegaly:a review of 23 cases

Objective To study the efficacy of somatostatin analogues(SSA) with surgery combined in patients with acromegaly.Methods We performed a retrospective study on the clinical profiles in 23 patients with pathologically-confirmed acromegaly who were treated with presurgical SSA in combination with transsphenoidal tumor resection and underwent long-term followed-ups in the department of endocrinology,Peking Union Hospital between January 1st,2005 and December 31st,2008.Results Treatment with SSA in patients with acromegaly for >3 months led to marked reduction in the nadir of growth hormone(GH)(P<0.01) and shrinking of tumor volume(P=0.012).Biochemically controlled group(GH<0.047 nmol/L) yielded considerbly smaller tumor size than uncontrolled group(GH≥0.047 nmol/L)(P=0.015) prior to the surgery.In addition,both initial and final GH nadirs were reduced postoperatively(P=0.002 and 0.018,respectively).Conclusion SSAs in patients with acromegaly may be associated with improved efficacy of surgery as a result of reduced GH level and shrinked tumor volume prior to surgery.Preoperative detection of GH nadir via OGTT may be applied to assess the prognosis of patients with acromegaly.