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生长抑素受体配体对肢端肥大症患者骨代谢的影响

Effects of somatostatin receptor ligands on bone metabolism in acromegaly
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摘要 目的探讨生长抑素受体配体(SRLs)对肢端肥大症患者骨代谢的影响。方法回顾性分析接受手术治疗或单纯使用SRLs治疗3个月的100例肢端肥大症患者临床资料。比较患者治疗前及治疗后生长激素(GH)、胰岛素样生长因子1(IGF-1)、骨钙素(OC)、骨钙素N端中分子片段(N-MID)、Ⅰ型前胶原氨基端肽(P1NP)及Ⅰ型胶原C端肽降解产物(CTX)的变化。根据治疗方法将患者分为药物组和手术组。根据用药后GH下降程度, 进一步将药物组患者分为药物敏感组和药物不敏感组。结果药物组治疗后平均动态GH、IGF-1指数较治疗前均显著降低(均P<0.05), 治疗后CTX较治疗前显著下降[1.25(0.67, 1.40)ng/mL对1.34(0.57, 1.68)ng/mL,P<0.05]。手术组治疗后平均动态GH、IGF-1指数、OC、N-MID、P1NP及CTX较治疗前均显著下降(均P<0.01)。手术组治疗前后GH差值(ΔGH)与N-MID差值(ΔN-MID)呈正相关(r=0.454,P=0.026), IGF-1差值(ΔIGF-1)与CTX差值(ΔCTX)呈正相关(r=0.339,P=0.036)。治疗后, 药物组平均动态GH、IGF-1指数、CTX、P1NP、N-MID均显著高于手术组(均P<0.001)。药物敏感组CTX、N-MID在治疗后降幅显著高于药物不敏感组(35.3%对7.2%,P<0.001;24.1%对11.8%,P<0.05), 且ΔGH与ΔCTX呈正相关(r=0.328,P=0.004)。结论 SRLs治疗肢端肥大症可以降低患者的骨形成标志物N-MID及骨吸收标志物CTX, 从而改善其骨代谢高转换状态, 该作用与降低GH和IGF-1水平有关。 Objective To investigate the effect of somatostatin receptor ligands(SRLs)on bone metabolism in patients with acromegaly.Methods Retrospective analysis of clinical data of acromegaly patients(n=100)received surgery or SRLs alone for 3 months.The changes of growth hormone(GH),insulin-like growth factor-1(IGF-1),osteocalcin(OC),N-mid fragment of osteocalcin(N-MID),amino-terminal peptide of type I procollagen(P1NP)and C-terminal peptide degradation product of type I collagen(CTX)were compared before and after treatment.Patients were divided into drug treatment group and surgical group according to treatment methods.According to the decline of GH after medication,patients in the drug treatment group were further divided into drug sensitive group and drug insensitive group.Results The average dynamic GH and IGF-1 indexes in the drug treatment group were significantly decreased after treatment compared with before treatment(both P<0.05),and CTX was also significantly decreased after treatment[1.25(0.67,1.40)ng/mL vs 1.34(0.57,1.68)ng/mL,P<0.05].The mean dynamic GH,IGF-1 index,OC,N-MID,P1NP,and CTX in surgical group were significantly decreased after treatment compared with before treatment(all P<0.01).In the surgical group,there was a positive correlation between GH difference(ΔGH)and N-mid difference(ΔN-MID;r=0.454,P=0.026),and there was a positive correlation between IGF-1 index difference(ΔIGF-1 index)and CTX difference(ΔCTX;r=0.339,P=0.036).After treatment,the mean dynamic GH,IGF-1 index,CTX,P1NP,and N-MID in drug treatment group were significantly higher than those in surgical group(all P<0.001).CTX and N-MID decreased significantly after treatment in drug sensitive group compared with drug insensitive group(35.3%vs 7.2%,P<0.001;24.1%vs 11.8%,P<0.05),andΔGH was positively correlated withΔCTX(r=0.328,P=0.004).Conclusion SRLs treatment can reduce bone formation marker N-MID and bone resorption marker CTX,improving the high turnover state of bone metabolism in patients with acromegaly,which may attribute to the reduction of GH and IGF-1 levels.
作者 孙菲 俞一飞 王蒙 谢丽杰 黄新梅 孙全娅 何敏 王镛斐 赵曜 叶红英 李益明 张朝云 Sun Fei;Yu Yifei;Wang Meng;Xie Lijie;Huang Xinmei;Sun Quanya;He Min;Wang Yongfei;Zhao Yao;Ye Hongying;Li Yiming;Zhang Zhaoyu(Department of Endocrinology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Neurosurgery,Huashan Hospital,Fudan University,Shanghai 200040,China)
出处 《中华内分泌代谢杂志》 CAS CSCD 北大核心 2022年第6期517-521,共5页 Chinese Journal of Endocrinology and Metabolism
基金 国家重大疾病多学科合作诊疗能力建设项目(3030248001) 上海申康医院发展中心临床研究培育项目(SHDC12018X04)。
关键词 肢端肥大症 生长抑素受体配体 肢端肥大症骨病 骨代谢 骨质疏松 Acromegaly Somatostatin receptor ligand Acromegaly bone disease Bone metabolism Oteoporosis
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