垂体生长激素腺瘤患者糖代谢异常特点及经蝶手术对其影响

Characteristics of glucose metabolism in patients with pituitary growth hormone secreting adenomas and the impact of trans-sphenoid surgery

目的研究生长激素腺瘤患者糖代谢异常的特点,并探讨手术对其影响.方法回顾性收集2011年11月至2016年4月在华山医院神经外科接受经蝶手术的生长激素腺瘤患者术前及术后1年随访的临床资料,分析术前糖代谢异常患病率;比较不同糖代谢状态患者的胰岛素抵抗水平和β细胞功能;分析手术后糖代谢特点的变化;根据术后生长激素(GH)及胰岛素样生长因子?1的恢复程度进行亚组分析,比较术后糖代谢变化的差异.采用Logistic回归分析法分析影响糖代谢转归的相关因素.结果共入组81例生长激素腺瘤患者,术前糖代谢异常患病率为69.1%(56/81).正常糖耐量(NGT)组、糖尿病前期(preDM)组和糖尿病(DM)组胰岛素抵抗水平差异无统计学意义,DM组稳态模型β细胞功能指数[66.25(28.90,129.76)%]、胰岛素生成指数[2.24(1.34,9.97)]显著低于preDM组[分别为195.30(141.00,260.00)%、32.65(8.56,48.35)]和NGT组[分别为176.25(140.63,218.14)%、30.69(11.98,51.38)](F=27.050、20.690,均P<0.05).67.9%(38/56)的糖代谢异常患者术后糖代谢恢复正常.与术前相比,术后完全缓解组、GH缓解组患者糖化血红蛋白(HbA1c)显著降低[分别为(6.4±1.5)%比(5.7±0.7)%、(6.2±1.2)%比(5.5±0.5)%,t=3.780、3.378,均P<0.05],但未缓解组变化无统计学意义.β细胞功能指标在完全缓解组、GH缓解组和未缓解组分别有4项、3项和2项改善.Logistic回归分析显示,基线HbA1c、手术后生化缓解状态与术后糖代谢是否恢复正常相关(均P<0.05).结论β细胞功能损害是生长激素腺瘤患者发生糖尿病的决定因素;术前HbA1c和术后生化缓解状态影响术后糖代谢转归.

Objective To investigate the characteristics of glucose metabolism in patients with growth hormone (GH) secreting adenomas and the impact of trans-sphenoid surgery. Methods Preoperative and postoperative clinical information of patients with GH secreting adenomas who underwent trans-sphenoidal surgery in department of neurosurgery of Huashan Hospital from November 2011 to April 2016 were collected. Preoperative prevalence of abnormal glucose metabolism was analyzed;insulin resistance and β cell function were compared among different glucose tolerance groups;changes in the characteristics of glucose metabolism after operation were analyzed. Subgroup analysis was performed according to the recovery of GH and insulin-like growth factors-1 (IGF-1) after operation, and changes of glucose metabolism in different subgroups after operation were compared. Logistic regression analysis was used to analyze the risk factors of glucose metabolism outcome after operation. Results A total of 81 patients were enrolled in this study. The preoperative prevalence of abnormal glucose metabolism was 69.1%(56/81). There was no difference in insulin resistance among normal glucose tolerance (NGT) group, pre-diabetes mellitus (preDM) group and diabetes mellitus (DM) group. Homeostasis medel assessment of insulin resistance [66.25(28.90, 129.76)%] and insulinogenesis index [2.24(1.34, 9.97)] in DM group were significantly lower than those in preDM group [195.30(141.00, 260.00)%, 32.65(8.56, 48.35), respectively] and NGT group [176.25(140.63, 218.14)%, 30.69(11.98, 51.38), respectively](F=27.050, 20.690, both P< 0.05). 67.9%(38/56) of patients with abnormal glycometabolism recovered to NGT after operation. Compared with pre-operation, glyacted hemoglobin (HbA1c) in complete remission group and GH remission group decreased significantly after operation [(6.4±1.5)% vs (5.7±0.7)%,(6.2±1.2)% vs (5.5±0.5)%, respectively, t=3.780, 3.378, both P<0.05], with no significant change in non-remission group. In the complete remission group, GH remission group and non-remission group there are 4, 3 and 2 indexes reflecting β-cell function improved respectively. Logistic regression analysis showed that baseline HbA1c and biochemical remission state were correlated with the outcome of glucose metabolism after operation (all P<0.05). Conclusions Impairment of β cell function is the decisive factor for developing DM in patients with GH secreting adenomas. Preoperative HbA1c level and postoperative biochemical remission states affect the outcome of glucose metabolism after operation.