长效生长抑素治疗对肢端肥大症术后患者糖脂代谢的影响

Impact of long-acting somatostatin analogues on glycolipid metabolism in postoperative patients with acromegaly

目的分析肢端肥大症患者手术治疗后生长激素(GH)控制不完全缓解,应用长效生长抑素治疗对其血糖、血脂、胰岛素抵抗程度及胰岛功能的影响。方法采用治疗前后病例自身对照研究,选择2016年1月至2018年1月在首都医科大学附属北京天坛医院明确诊断并手术治疗的肢端肥大症30例患者,所有患者术后因GH水平控制不完全缓解,均应用长效生长抑素治疗1年以上,治疗前及治疗1年后行75 g葡萄糖胰岛素C肽释放试验及口服葡萄糖抑制试验,应用稳态模型评估胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β),评价注射用醋酸奥曲肽微球治疗对患者胰岛素抵抗及胰岛功能的影响。结果注射用醋酸奥曲肽微球治疗1年后,患者GH、胰岛素样生长因子1(IGF-1)、HOMA-IR、HOMA-β、三酰甘油(TG)较治疗前均有下降[(2.8±2.5)μg/L比(12.1±10.5)μg/L、(356.8±209.2)μg/L比(698.1±207.3)μg/L、1.56±1.08比2.71±1.52、1.01±0.97比4.87±3.57、(1.12±0.49)mmol/L比(1.76±0.92)mmol/L],差异有统计学意义(P<0.05);治疗后空腹血糖较治疗前升高[(5.83±1.19)mmol/L比(5.11±1.73)mmol/L],差异有统计学意义(P<0.05);而治疗前后口服葡萄糖耐量试验2 h血糖、糖化血红蛋白、总胆固醇、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇水平比较差异无统计学意义(P>0.05)。结论注射用醋酸奥曲肽微球治疗可有效改善肢端肥大症患者的胰岛素敏感性,胰岛素抵抗有所改善,β细胞功能减低,使患者空腹血糖轻度升高,但对糖化血红蛋白无不良影响,可降低患者的TG水平。

Objective To analyze the effect of long-acting somatostatin treatment on blood glucose,blood lipid,insulin resistance and islet function in patients with acromegaly after surgical treatment.Methods Self-control study before and after treatment was used.A total of 30 subjects who were diagnosed as acromegalyand received surgical treatment in Beijing Tiantan Hospital from January 2016 to January 2018 were enrolled in this study.Because patients′growth hormone(GH)level was notc ompletely controlled after surgery,all the patients were treated with long-acting octreotide for more than 1 year.Before and 1 year after treatment,oral glucose tolerance testing(OGTT)was performed at pretreatment and 1 year after initiation of treatment with long-acting octreotide.Homeostatic model assessment(HOMA)was used to estimate insulin resistance(HOMA-IR)andβ-cell function(HOMA-β).The HOMA-IR and HOMA-βwere detected by 75 g glucose,insulin,C peptide release test and growth hormone suppression test to evaluate the therapy effects on insulin resistance and islet function.Results The levels of GH,insulin-like growth factor 1(IGF-1),HOMA-IR,HOMA-β,and triacylglycerol(TG)were all decreased after 1 year of octreotide treatment compared with that before treatment:(2.8±2.5)μg/L vs.(12.1±10.5)μg/L,(356.8±209.2)μg/L vs.(698.1±207.3)μg/L,1.56±1.08 vs.2.71±1.52,1.01±0.97 vs.4.87±3.57,(1.12±0.49)mmol/L vs.(1.76±0.92)mmol/L,and the differences were statistically significant(P<0.05).After treatment,the level of fasting blood glucose was increased compared with that before treatment:(5.83±1.19)mmol/L vs.(5.11±1.73)mmol/L,and the difference was statistically significant(P<0.05).While there were no significant changes in postprandial 2 h blood glucose and glycosylated hemoglobin(GHb),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)levels before and after treatment(P>0.05).Conclusions Long-acting somatostatin therapy can effectively improve the insulin sensitivity of acromegaly patients,reduceβcell function,and slightly increase fasting blood glucose.It has no adverse effect on GHb,and can reduce the level of TG of the patients.