肢端肥大症患者糖代谢异常和相关指标分析

目的:评估肢端肥大症患者糖代谢异常及相关生化指标，探讨临床特点、生化指标和糖代谢的联系。方法:回顾性分析天津医科大学总医院内分泌代谢科51例初治肢端肥大症患者病历资料女31例，男20例，平均年龄（49.51±12.07）岁]，所有患者均接受75 g口服葡萄糖糖耐量试验（OGTT），根据血糖水平将患者分为正常糖代谢（NGT）组、糖调节受损（IGR）组以及糖尿病（DM）组，比较3组患者的临床特点及生化指标，计算稳态模型评估-胰岛素抵抗指数（HOMA-IR）及稳态模型评估-胰岛β细胞功能指数（HOMA-β），分析年龄、家族史、生长激素（GH）、胰岛素样生长因子-1（IGF-1）与血糖（Glu）、HOMA-IR、HOMA-β、血糖处置指数（DI）和松田指数（MI）的相关性，并通过Logistic回归分析肢端肥大症患者发生糖尿病的相关危险因素。结果:NGT组14例，占27.4%，IGR组13例，占25.4%，DM组24例，占47.1%。DM组年龄高于NGT组、IGR组，但差异均无统计学意义。DM组糖化血红蛋白（HbA1c）水平高于IGR组、NGT组（F=8.12，P=0.000），且DM组胰岛素抵抗最严重。与IGR组、NGT组相比，DM组HOMA-β、30 min血糖处置指数（DI30）、120 min血糖处置指数（DI120）、松田指数（MI）和早期胰岛素分泌（AUC Ins 30/AUC Glu 30）、总胰岛素分泌（AUC Ins 120/AUC Glu 120）较NGT组、 IGR组均明显下降（F=21.12、50.50、55.53、5.54、13.52、15.77，均P<0.05）；3组之间GH、IGF-1差异无统计学意义（F=2.27、2.12，均P>0.05）。3组OGTT后0、30、60、120、180 min Glu差异有统计学意义，在30、60、120 min胰岛素差异有统计学意义，而在各个时间点GH水平均无统计学差异；GH、IGF-1水平与HOMA-β以及HOMA-IR未见相关性；年龄与HOMA-β呈负相关（r=-0.560，P=0.000），与OGTT 120 min Glu呈正相关（r=0.340，P=0.013）。Logistic回归分析显示，糖尿病家族史比无家族史OGTT 120 min 血糖水平高（β=4.76，P=0.032）。结论:年龄和糖尿病家族史是肢端肥大症发生糖代谢紊乱的危险因素。GH和IGF-1水平与糖代谢紊乱没有相关性。

Analysis of abnormal glucose metabolism and related indexes in patients with acromegaly

Objective: To evaluate the abnormal glucose metabolism and related biochemical indexes in patients with acromegaly， and to discuss the relationship between clinical characteristics， biochemical indexes and glucose metabolism. Methods: Fifty-one patients with acromegaly31 women，20 men，mean age（49.51±12.07）years old] were analyzed regressively in the Department of Endocrine and Metabolism， General Hospital，Tianjin Medical University. All patients underwent an oral 75 g of glucose tolerance test （OGTT）. According to the blood glucose level，the patients were divided into normal glucose metabolism group（NGT group）， impaired glucose regulation group（IGR group） and diabetic group（DM group），and the clinical characteristics and biochemical indexes among the three groups were compared. Then homeostasis model assessment of insulin resistance（HOMA-IR） and homeostasis model assessment of β-cell function（HOMA-β）were calculated，and the correlation between age，family history，GH，IGF-1 and blood glucose，HOMA-IR，HOMA-β，blood glucose esposition index（DI）， Matsuda index（MI）were analyzed. The related risk factors of diabetes in patients with acromegaly were analyed by Logistic regression analysis. Results: There were 14 people（27.4%）in NGT group，13（25.4%）in IGR group， and 24（47.1%） in DM group， respectively .The age of DM group was higher than that of NGT group and IGR group， but the difference was not statistically significant.The HbA1c of DM group was higher than that in IGR group and NGT group（F=8.12，P=0.000）， and the insulin resistance in DM group was the most serious.The HOMA-β， DI at 30 minutes（DI30），DI at 120 minutes（DI120），MI， islet secretion index AUC Ins 30/AUC Glu 30 and AUC Ins 120/AUC Glu 120 in DM group were significantly lower than those in IGR group and NGT group（F=21.12，50.50， 55.53，5.54，13.52，15.77，all P <0.05）， however the level of GH and IGF-I was not significant difference among the three groups（F=2.27，2.12，P>0.05）.There were significant differences in blood glucose at 0，30，60，120 and 180 min and in insulin at 30，60 and 120 min after OGTT among the three groups， but there was no significant difference in GH level at each time point.The level of GH and IGF-1 were not correlated with HOMA-β and HOMA-IR. Age was negatively correlated with HOMA-β（r=-0.560，P =0.000），and positively correlated with OGTT 120 min blood glucose（r =0.345，P=0.013）. Linear regression analysis showed that the OGTT 120 min blood glucose level in the patients who have the family history of diabetes was higher than that of withowt family history（β=4.76，P=0.032）. Conclusion: Age and family history of diabetes are the risk factors of secondary diabetes in acromegaly. On the contrary， there is not significant correlation between the levels of GH or IGF-1 and the disorder of glucose metabolism.