Surgical outcomes and predictors of glucose metabolism alterations for growth hormone-secreting pituitary adenomas: a hospital-based study of 151 cases
Surgical outcomes and predictors of glucose metabolism alterations for growth hormone-secreting pituitary adenomas: a hospital-based study of 151 cases
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生长激素分泌垂体腺瘤的手术结果和葡萄糖代谢改变的预测因素：一项针对 151 例病例的医院研究
DOI：
10.1007/s12020-018-1745-7
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发表时间：
2019-01-01
期刊：
影响因子：
3.7
通讯作者：
Wang, Yongfei
中科院分区：
文献类型：
--
作者：
He, Wenqiang;Yan, Linling;Wang, Yongfei
目的肢端肥大症患者的手术结果对糖代谢的影响尚不完全清楚。目的探讨手术对肢端肥大症患者糖代谢的影响，找出影响糖代谢状态改变的关键因素。方法对151例初诊肢端肥大症患者在手术前和术后3~12个月进行口服糖耐量试验。对胰岛素抵抗和胰岛素分泌进行评估。根据术后生长激素(GH)和胰岛素样生长因子-1(IGF-1)水平将患者分为治愈、不适和活动期。结果基线时，糖耐量正常(NGT)、糖耐量受损(IGT)和糖尿病(DM)患者分别占32.5%、41.7%和25.8%。手术后87.3%的IGT患者和66.7%的DM患者糖耐量改善。14.3%的NGT患者病情恶化。术前空腹血糖、2 h-BG和HbA1c降低、HOMA-β和IGI/IR升高的患者糖耐量改善。在手术治愈的患者(28.3%比79.2%，P<； 0.001)和生长激素正常但胰岛素样生长因子-1水平升高的患者(25.6%比79.5%，P <； 0.001)中，NGT的比例显著增加，而在活动期疾病患者中(42.9%比57.1%，P= 0.131)。基线空腹血糖 <； 6.35mmo1/L预测手术后糖代谢改善。结论在保留 细胞功能的情况下，患者的糖代谢状况有所改善。术前空腹血糖是术后糖耐量改善的独立预测因子。
PurposeThe surgical outcome on glucose metabolism in acromegaly patients is not fully understood. We aimed to investigate the impact of surgery on glucose metabolism and identify key factors that influence alterations of glucose metabolic status in acromegaly patients.MethodsOral glucose tolerance test was performed in 151 newly diagnosed acromegaly patients before and 3–12 months after surgery. Insulin resistance and insulin secretion was assessed. Patients were grouped as cured, discordant, and having active disease according to postoperative growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels. Receiver-operating characteristic curves were generated to determine the optimal cut-off points to predict the impact of surgery on glucose metabolism.ResultsAt baseline, 32.5%, 41.7%, and 25.8% patients were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM), respectively. After surgery, improved glucose tolerance was observed in 87.3% patients with IGT and 66.7% patients with DM. Deterioration was observed in 14.3% patients with NGT. Glucose tolerance improved in patients with lower preoperative FBG, 2 h-BG, and HbA1c and higher HOMA-β and IGI/IR. The proportion of NGT was significantly increased in surgically cured patients (28.3% vs. 79.2%,P< 0.001) and those with normal GH but elevated IGF-1 levels (25.6% vs. 79.5%, P < 0.001), but not in patients with active disease (42.9% vs. 57.1%,P= 0.131). Baseline FBG < 6.35 mmol/l predicted improved glucose metabolism after surgery.ConclusionsGlucose metabolic status improved in patients with preserved β-cell function. Preoperative FBG was an independent predictor for improved glucose tolerance status after surgery.