94例肢端肥大症住院患者的临床病理及疗效分析

Analysis of clinicopathological characteristics and therapeutic effect in 94 hospitalized patients with acromegaly

摘要:

目的整理94 例肢端肥大症住院患者的临床资料，探讨诊断准确性与疗效，阐明其临床特征。方法采用回顾性研究，应用SPSS 22.0统计软件进行分析。结果94例患者中，男性31 例（33.0%）、女性63 例（67.0%），就诊年龄14～72 岁，以41～50岁比例最大（35.1%）。首发症状中，容貌改变或手足改变78 例（83.0%），头痛43例（45.7%），视力下降或视野缺损41 例（43.6%），闭经或泌乳11 例（11.7%），不育或性功能障碍2 例（2.1%）。影像学检查，CT检出10 例（10.6%），MRI检出84例（89.4%），明确描述肿瘤大小66例，大腺瘤及巨大腺瘤占93.94%，微腺瘤仅为6.06%。血清生长激素（GH）水平与肿瘤大小呈正相关（P <0.05）。93 例行手术治疗，除微腺瘤外，术后血清GH 水平较术前下降。行手术治疗同时完善免疫组织化学检查共90 例，GH 表达阳性占94.45%；ROC 曲线显示，术前血清GH 水平与术后免疫组织化学GH 表达情况无关。结论94 例患者，女性多于男性，就诊年龄主要集中于31～60 岁，首发症状以容貌改变或手足改变、头痛、视力下降或视野缺损多见，大腺瘤及巨大腺瘤居多。GH水平与肿瘤大小呈正相关，且手术治疗可使GH水平降低。免疫组织化学GH 表达情况与术前血清GH 水平不完全符合，GH 水平对免疫组织化学GH 表达阳性患者的诊断准确性较低。

Abstract:

Objective To collate clinical data of 94 hospitalized patients with acromegaly, explore the diagnostic accuracy and the therapeutic effect, and clarify the clinical features. Methods This retrospective study was analyzed using SPSS 22 software. Results In the 94 patients, 31 were males (33.0%) and 63 were females (67.0%). The age at diagnosis ranged from 14 to 72 years with the largest proportion of 41-50 years (35.1%). Among the initial symptoms, changes of appearance or limbs occurred in 78 patients (83.0%),headache in 43 patients (45.7%), vision loss or visual field defect in 41 patients (43.6%), amenorrhea or lactation in 11 patients (11.7%), and sterility or sexual dysfunction in 2 patients (2.1%). In the aspect of imaging examinations, 10 patients were diagnosed with CT (10.6%) and 84 patients with MRI (89.4%). There were 66 imaging results with clear description of tumor size (displayed as the maximal tumor diameter), macroadenomas and giant adenomas of pituitary gland accounted for 93.94% and microadenomas accounted for 6.06%. Serum GH level was positively correlated to tumor size. There were 93 patients treated with surgery, the serum GH level was lowered after operation except the patients with microadenomas. After surgery, 90 patients accepted immunohistochemical examination, in which 94.45% had GH positive expression. The receiver operating characteristic curve showed preoperative serum GH level was not correlated with postoperative immunohistochemical results of GH expression. Conclusions Among the 94 patients, women were more than men, their age range at diagnosis concentrated in 31-60 years. The primary initial symptoms were changes of appearance or limbs, headache, vision loss or visual field defect. Macroadenomas and huge adenomas were the majority. Serum GH level was positively correlated with tumor size and could be reduced after surgery. Immunohistochemical expression of GH was not completely in accordance with preoperative serum level of GH. The diagnostic accuracy of GH level to GH expression of immunohistochemical results was low.