垂体生长激素瘤并发神经病变的影响因素分析

Analysis of the factors affecting the occurrence of neuropathy in growth hormone-secreting pituitary adenoma

摘要:

目的 探讨垂体生长激素瘤并发神经病变的影响因素。方法 选取2013年10月—2021年3月首都医科大学附属北京天坛医院内分泌科收治的54例生长激素瘤住院患者。收集患者一般资料、病史、生化指标及神经电生理检查指标等，根据神经电生理检测指标将患者分为多发性周围神经病变组（PN组）、腕管综合征组（CTS组）、交感神经功能障碍组（SND组）和无神经病变组。比较不同组临床资料及生化指标的差异，同时探索不同神经电生理参数与糖化血红蛋白（HbA1c）、生长激素葡萄糖抑制试验中生长激素（GH）谷值间的相关性。结果 有神经病变组神经电生理检查时年龄大于无神经病变组，HbA1c高于无神经病变组。两组BMI、诊断生长激素瘤时的年龄、IGF-1指数、IGFBP-3、GH谷值比较，差异无统计学意义（P >0.05）。PN组HbA1c、GH谷值高于CTS组、SND组和无神经病变组，而各组性别、神经电生理检查时年龄、身高、体重、BMI、IGF-1、IGF-1指数、IGFBP-3比较，差异无统计学意义（P >0.05）。相关性分析显示，感觉神经电生理检测指标中，正中神经潜伏期（指Ⅰ-腕）、正中神经潜伏期（指Ⅲ-腕）与HbA1c呈正相关（r =0.401、0.312，P <0.05），正中神经动作电位波幅（指Ⅰ-腕）、正中神经动作电位波幅（指Ⅲ-腕）、正中神经传导速度（指Ⅰ-腕）、正中神经传导速度（指Ⅲ-腕）与HbA1c呈负相关（r =-0.423、-0.374、-0.365和-0.388，均P <0.05）。GH谷值与感觉神经电生理检测指标无相关性（P >0.05）。运动神经电生理检测指标中，正中神经潜伏期、尺神经潜伏期、腓总神经潜伏期与HbA1c呈正相关（r_s =0.418、0.393和0.310，均P <0.05），正中神经传导速度、腓总神经传导速度与HbA1c呈负相关（r_s =-0.386和-0.453，均P <0.05）。而胫神经潜伏期与GH谷值水平呈正相关（r_s =0.300，P <0.05），腓总神经传导速度与GH谷值呈负相关（r_s =-0.436，P <0.05）。交感神经电生理检测指标中，右上肢波幅与HbA1c呈负相关（r_s =-0.323、P <0.05），与潜伏期无相关性（P >0.05）。GH谷值与交感皮肤反应潜伏期、波幅无相关性（P >0.05）。结论 相较于腕管综合征，垂体生长激素瘤患者病情活动及血糖控制不佳更易并发多发性周围神经病变，因此，应积极控制血糖与GH水平，并通过神经电生理检查早期识别神经病变。

Abstract:

Objective To explore the factors affecting the occurrence of neuropathy in growth hormone-secreting pituitary adenoma.Methods We retrospectively analyzed the data of 54 inpatients with growth hormone-secreting pituitary adenoma admitted to the Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University from October 2013 to March 2021. The general information, medical history, biochemical indicators and electrophysiological parameters were collected. Based on the electrophysiological parameters, the patients were divided into polyneuropathy group (PN group), carpal tunnel syndrome group (CTS group), sympathetic nervous dysfunction group (SND group) and normal group. The clinical data and biochemical indicators were compared among the four groups, and the correlations between electrophysiological parameters and glycosylated hemoglobin (HbA1c) and the growth hormone (GH) nadir during the oral glucose tolerance test were investigated.Results The age of the patients when undergoing the electrophysiological examination was older, and the HbA1c level was higher in patients with neuropathy than those without. There was no difference in the body mass index (BMI), the age at the diagnosis of growth hormone-secreting pituitary adenoma, insulin-like growth factor-1 (IGF-1) index, IGF-binding protein 3 (IGFBP-3) or GH nadir between patients with and without neuropathy (P > 0.05). The HbA1c level and GH nadir were higher in PN group than those in the other three groups (P < 0.05), while the sex ratio, the age of the patients when undergoing the electrophysiological examination, height, weight, BMI, IGF-1, IGF-1 index and IGFBP-3 were not different among these groups (P > 0.05). The correlation analysis revealed that the median nerve sensory latencies (digit Ⅰ-wrist and digit Ⅲ-wrist) were positively correlated with the HbA1c level (r =0.401 and 0.312, P < 0.05), while the action potential amplitudes and the conduction velocities of the median nerve (digit Ⅰ-wrist and digit Ⅲ-wrist) were negatively correlated with the HbA1c level (r =-0.423, -0.374, -0.365 and -0.388, all P < 0.05). There was no difference between GH nadir and the electrophysiological parameters of the sensory nerve (P > 0.05). The motor latencies of median nerve, ulnar nerve and common peroneal nerve were positively correlated with the HbA1c level (r_s =0.418, 0.393 and 0.310, all P < 0.05), whereas the motor conduction velocities of median nerve and common peroneal nerve were negatively correlated with the HbA1c level (r_s = -0.386 and -0.453, both P < 0.05). The GH nadir was positively correlated with the motor latency of tibial nerve (r_s = 0.300, P < 0.05) and negatively correlated with the motor conduction velocity of common peroneal nerve (r_s = -0.436, P < 0.05). As for the electrophysiological parameters for the sympathetic functions, the amplitude of right upper limb showed a negative correlation with the HbA1c level (r_s =-0.323, P < 0.05), but the latency was not correlated with the HbA1c level (P >0.05). There was no correlation between GH nadir and the latency and amplitude of the sympathetic skin response (P >0.05).Conclusions Compared with CTS patients, those with growth hormone-secreting pituitary adenoma are more likely to develop polyneuropathy due to the uncontrolled disease and blood glucose. Therefore, blood glucose and GH levels should be well managed, and electrophysiological examinations should be performed to early identify the occurrence of neuropathy.