DOES TREATMENT OF ACROMEGALY AFFECT LIFE EXPECTANCY
DOES TREATMENT OF ACROMEGALY AFFECT LIFE EXPECTANCY
复制标题
DOI：
10.1016/0026-0495(95)90303-8
复制
发表时间：
1995-01-01
影响因子：
9.8
通讯作者：
CLAYTON, RN
中科院分区：
文献类型：
--
作者：
BATES, AS;VANTHOFF, W;CLAYTON, RN
先前的研究表明，肢端肥大症患者的死亡率增加了两倍至三倍，主要是由于心血管疾病的增加，但在某些系列中也是由于恶性疾病的增加。在对英国一家大型医院中心的79例患者进行的回顾性分析中，我们试图确定（1）死亡率是否持续增加，（2）死亡率与治疗后生长激素（GH）水平之间的关系。医院记录和死亡证明进行了仔细检查，血清GH数据收集的患者在1967年和1991年之间接受治疗。在随访评价期间，平均每年进行一次GH评估，包括GH日间系列中清醒时间内的3小时测量。从五个读数计算平均值。我们使用最低值，通常是最近的，用于随访期间达到的平均GH。有29名男性和50名女性，在存活组和死亡组中没有发现性别之间的数字差异。将该队列的死亡率与一般人群的死亡率进行比较，并根据人口普查统计局的数据计算预期死亡率。确定观察值与预期值的比值。在诊断时，高血压、糖尿病或视野缺损的受试者比例在存活组和死亡组之间没有差异。大多数患者接受放疗+/-溴隐亭作为主要治疗。治疗后平均GH值显著降低，79例患者中有48例的值低于10 mU/L。平均GH水平低于5 mU/L的受试者血清胰岛素样生长因子-I（IGF-IJ）值显著低于高于该水平的受试者。观察到的死亡率与预期死亡率的比值（括号内为95%置信区间）如下：男性，2.55（1.4-4.3），P = 0.002;女性，2.83（1.6-4.8），P = 0.001;总死亡率，2.63（1.8-3.9），P = 0.001。
Previous studies have demonstrated a twofold to threefold increase in mortality in acromegalic patients largely due to increased cardiovascular disease, but also in some series due to increased malignant disease. In a retrospective analysis of 79 patients from one large hospital center in the United Kingdom, we sought to determine (1) whether the increased mortality persists and (2) what is the relationship between mortality and growth hormone (GH) levels achieved following treatment. Hospital records and death certificates were scrutinized and serum GH data collected from patients treated between 1967 and 1991. GH assessments were performed on average annually during follow-up evaluation and consisted of 3-hour measurements during waking hours in a GH day series. The average value was calculated from five readings. We used the lowest value, usually the most recent, for average GH achieved during the follow-up period. There were 29 males and 50 females, and no numerical difference between sexes was found in living and deceased groups. The mortality of the cohort was compared with that of the general population, and expected mortality was calculated from Office of Population Census Statistics data. The observed to expected ratio was determined. There were no differences between living and deceased groups in the proportion of subjects with hypertension, diabetes, or visual field defects at the time of diagnosis. Most patients were treated with radiotherapy +/- bromocriptine as primary therapy. There was a marked shift to lower mean GH values with treatment such that 48 of 79 had values less than 10 mU/L. Those subjects with mean GH levels less than 5 mU/L had significantly lower serum insulin-like growth factor-l (IGF-IJ values than subjects with values above this level. The observed to expected mortality ratios (with 95% confidence intervals in parentheses) were as follows: males, 2.55 (1.4-4.3), P =.002; females, 2.83 (1.6-4.8), P =.001; total, 2.63 (1.8-3.9), P