[1]刘洪宇,李征,郭莹,等.肢端肥大症患者治疗前后心脏结构和功能的变化[J].国际内分泌代谢杂志,2021,41(04):318-322.[doi:10.3760/cma.j.cn121383-20200723-07060]
　Liu Hongyu,Li Zheng,Guo Ying,et al.Changes of cardiac structure and function in patients with acromegaly before and after treatment[J].International Journal of Endocrinology and Metabolism,2021,41(04):318-322.[doi:10.3760/cma.j.cn121383-20200723-07060]
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肢端肥大症患者治疗前后心脏结构和功能的变化()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
41
期数:
2021年04期
页码:
318-322
栏目:
论著
出版日期:
2021-07-20

文章信息/Info

Title:
Changes of cardiac structure and function in patients with acromegaly before and after treatment
作者:
刘洪宇; 李征; 郭莹; 梁丹; 王尧; 徐剑; 钟历勇
首都医科大学附属北京天坛医院内分泌科 100070
Author(s):
Liu Hongyu;  Li Zheng;  Guo Ying;  Liang Dan;  Wang Yao;  Xu Jian;  Zhong Liyong.
Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
关键词:
肢端肥大症;  生长激素;  胰岛素样生长因子-1;  心脏
Keywords:
Acromegaly;  Growth hormone;  Insulin-like growth factor-1;  Heart
DOI:
10.3760/cma.j.cn121383-20200723-07060
摘要:
目的 观察肢端肥大症患者手术和(或)伽马刀、长效奥曲肽治疗前后心脏结构及功能变化。方法 回顾性分析2016年1月至2019年10月在北京天坛医院诊断和治疗的62例肢端肥大症患者的一般临床资料和超声心动图检查结果,根据生长激素(GH)和胰岛素样生长因子-1(IGF-1)控制水平将治疗后患者分为病情控制组和未控制组,评估治疗前后心脏结构和功能变化。结果 与治疗前相比,治疗后GH和IGF-1水平显著下降,30例患者达到临床完全缓解。超声心动图可见,治疗后患者室间隔厚度(IVST)、左心室舒张末期内径(LVIDd)、左心室后壁厚度(LVPWT)降低,二尖瓣口血流频谱峰值血流速度比值(E/A)显著升高(P均<0.05); 而右心室前后径(RVLD)和射血分数(EF)差异无统计学意义。进一步将治疗后患者分为GH控制组和未控制组,GH控制组治疗后RVLD显著下降、E/A显著升高(P均<0.05),而未控制组RVLD和E/A差异无统计学意义。结论 肢端肥大症患者经治疗后心脏肥大明显改善,GH控制达标可提高E/A比值,有助于改善心脏舒张功能。
Abstract:
Objective To observe the changes of cardiac structure and function in acromegalic patients before and after operation, gamma knife and long-acting octreotide therapy.Methods A total of 62 acromegalic patients were enrolled at Beijing Tiantan Hospital between January 2016 and October 2019. The patients' serum hormone and general clinical data were analyzed retrospectively. All of them received echocardiography examination. According to the growth hormone(GH)and the insulin-like growth factor-1(IGF-1)level, the patients were divided into two groups: control group and uncontrolled group. The differences of cardiac structure and function between the two groups before and after treatment were evaluated.Results After operation, and/or gamma knife and/or octreotide therapy, the GH and IGF-1 level were significantly decreased; 30 of 62 patients achieved clinically complete remission. Patients' ventricular septal thickness(IVST), left ventricular diastolic diameter(LVIDd)and left ventricular posterior wall thickness(LVPWT)were decreased, while E/A was increased(all P<0.05); No significant difference was found in RVLD and EF. Further analysis found significantly decreased RVLD and increased E/A after treatment(all P<0.05)in GH control group instead of GH uncontrol group.Conclusion Patients with acromegaly have a significant improvement in cardiac hypertrophy after treatment. And GH control can improve E/A ratio and diastolic function.

参考文献/References:

[1] AlDallal S.Acromegaly:a challenging condition to diagnose[J].Int J Gen Med,2018,24; 11:337-343.DOI:10.2147/IJGM.S169611.
[2] Zahr R,Fleseriu M.Updates in diagnosis and treatment of acromegaly[J].Eur Endocrinol,2018,14(2):57-61.DOI:10.17925/EE.2018.14.2.57.
[3] Sharma MD,Nguyen AV,Brown S,et al.Cardiovascular disease in acromegaly[J].Methodist Debakey Cardiovasc J,2017,13(2):64-67.DOI:10.14797/mdcj-13-2-64.
[4] 中华医学会内分泌学分会,中华医学会神经外科学分会,中国垂体腺瘤协助组.中国肢端肥大症诊治指南[J].中国实用内科杂志,2013,33(7):519-524,529.10.3760/cma.j.issn.1001-2346.2013.10.003.
[5] 包薇萍,刘超.2014年美国内分泌学会成人肢端肥大症诊疗指南介绍[J].国际内分泌代谢杂志,2016,36(3):214-216.DOI:10.3760/cma.j.issn.1673-4157.2016.03.18.
[6] Melmed S,Bronstein MD,Chanson P,et al.A consensus statement one acromegaly therapeutic outcomes[J].Nat Rev Endocrinol,2018,14(9):552-561.DOI:10.1038/s4157 4-018-0058-5.
[7] Amado A,Araújo F,Carvalho D.Cardiovascular risk factors in acromegaly:what's the impact of disease control?[J].Exp Clin Endocrinol Diabetes,2018,126(8):505-512.DOI:10.1055/s-0043-124668.
[8] Puglisi S,Terzolo M.Hypertension and acromegaly[J].Endocrinol Metab Clin North Am,2019,48(4):779-793.DOI:10.1016/j.ecl.2019.08.008.
[9] Auriemma RS,Pivonello R,De Martino MC,et al.Treatment with GH receptor antagonist in acromegaly:effect on cardiac arrhythmias[J].Eur J Endocrinol,2012,168(1):15-22.DOI:10.1530/EJE-12-0596.
[10] 李群,王捷,徐秀英,等.60例肢端肥大症患者心脏结构和功能改变[J].首都医科大学学报,2006,27(2):214-217.DOI:10.3969/j.issn.1006-7795.2006.02.019.
[11] 郭晓鹏,高路,汪强,等.肢端肥大症手术前后心脏病变改善的临床研究[J].中国微侵袭神经外科杂志,2017,22(4):154-157.DOI:10.11850/j.issn.1009—122X.2017.04.003.
[12] Natchev E,Kundurdjiev A,Zlatareva N,et al.Echocardiographic myocardial changes in acromegaly:a cross-sectional analysis in a tertiary center in Bulgaria[J].Acta Endocrinol(Buchar),2019,5(1):52-61.DOI:10.4183/aeb.2019.52.
[13] Popielarz-Grygalewicz A,Gsior JS,Konwicka A,et al.Heart in acromegaly:the echocardiographic characteristics of patients diagnosed with acromegaly in various stages of the disease[J].Int J Endocrinol,2018,2018:6935054.DOI:10.1155/2018/6935054.

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备注/Memo

备注/Memo:
通信作者:钟历勇,Email: zhongliyong@126.com
更新日期/Last Update: 1900-01-01