摘要
目的：比较分析继发与不继发糖尿病的肢端肥大症型垂体腺瘤患者的临床资料，初步探讨肢端肥大症垂体腺瘤继发糖尿病的可能病理免疫学机制。方法回顾性分析2008年1月至2013年6月济宁医学院附属医院神经外科采用单鼻孔直达蝶窦入路显微手术切除的84例肢端肥大症垂体腺瘤患者的临床资料，运用免疫化学发光法测定术前基础血生长激素（GH）水平，使用多田公式（xyz／2）计算MRI上肿瘤体积，采用免疫组织化学的方法检测肿瘤内分泌激素的表达，采用χ2或t检验比较继发与不继发糖尿病的肢端肥大症垂体腺瘤患者在发病年龄、性别、发病时间、瘤体大小、基础血GH水平以及肿瘤激素免疫反应等方面的差异。结果20例（24％）肢端肥大症垂体腺瘤患者继发糖尿病。继发和不继发糖尿病的肢端肥大症垂体腺瘤患者男女均可发病（χ2＝1.944，P＝0.163），发病年龄多集中在41～50岁（P＝0.652），MRI显示瘤体大小均有微腺瘤、大腺瘤、巨大腺瘤，差异均无统计学意义（P＝1.000）；发病时间分别集中在1～5年（55％）、6～10年（45％），差异有统计学意义（P＝0.004）；术前基础血GH水平分别为（42.83±8.70）ng／ml、（38.91±36.46）ng／ml，差异有统计学意义（t＝5.253，P＝0.031）。继发糖尿病的肢端肥大症垂体腺瘤患者促甲状腺激素（TSH）免疫反应平均光密度值（0.545±0.023）明显高于不继发糖尿病者（0.408±0.019），差异有统计学意义（t＝5.336，P＝0.001）；TSH免疫反应阳性率（70％）亦明显高于不继发糖尿病的肢端肥大症患者（14％），差异有统计学意义（χ2＝23.971，P＝0.000）。结论继发与不继发糖尿病的肢端肥大症垂体腺瘤患者在发病年龄、性别、瘤体大小方面无明显差别，但二者在发病时间、术前基础血GH水平及肿瘤病理免疫反应方面存在明显差别，肿瘤细胞分泌的TSH可能参与了肢端肥大症垂体腺瘤继发糖尿病的病理生理过程。
Objective To compare and analyze the clinical data of patients with acromegalic pituitary adenoma between secondary and no secondary diabetes , and discuss the possible pathogenesis of acromegalic pituitary adenoma with secondary diabetic .Methods A total of 84 patients with acromegalic pituitary adenoma resected via single-nostril transspheniodal approach in Affiliated Hospital of Jining Medical College from Jan.2008 to Jun.2013 were analyzed retrospectively.Preoperative serum growth hormone（GH） levels were determined by chemiluminescent immunoassay .The tumor volume was calculated by the Coniglobus formula （ xyz/2 ） .The expression of endocrine hormone was detected by immunohistochemistry . The difference of acromegalic pituitary adenoma between secondary and no secondary diabetes in the age , gender,time of incidence,tumor size,basic blood GH level and tumor immune response were compared by usingχ2 or t test.Results Twenty cases（24%）in acromegalic pituitary adenoma patients complicated with secondary diabetes .Secondary and no secondary diabetes patients occurred in both men and women （χ2 =1.944,P=0.163）,the incidence age often concentrated in 41-50 old years（P=0.652）,MRI showed that tumor size were microadenomas , macroadenomas and giantadenomas , there were no significant differences （ P=1.000 ） .The incidence time of acromegalic pituitary adenoma with secondary diabetes mostly concentrated in 1-5 years （ 55%） , no secondary diabetes were more concentrated in 6-10 years （ 45%） , statistical differences were noted （ P=0.004 ） .The basic blood GH level of acromegalic pituitary adenoma with secondary and no secondary diabetes were （ 42.83 ±8.70 ） ng/ml and （ 38.91 ±36.46 ） ng/ml respectively,there was statistically significant difference between them （ t =5.253, P =0.031 ）.Thyroid stimulation hormone（TSH）immunoreactive intensity（0.545 ±0.023）of acromegalic pituitary adenoma with secondary diabetes was significantly higher than that of no secondary diabetes （ 0.408 ±0.019 ） , the difference was statistically significant （ t=5.336 ,P=0.001 ） .The percentage of secondary diabetes patients with positive TSH immunoreactivity（70%）was significantly more than that of no secondary diabetes （14%） （χ2 =23.971,P =0.000）.Conclusions There are no significant differences between secondary and no secondary diabetes of acromegalic pituitary adenoma in age ,gender,tumor size,but statistical differences are noted in incidence time ,preoperative basic blood GH level and pathological immune response .TSH of tumor cell secretion may be involved in the pathological and physiological process of acromegalic pituitary adenoma with secondary diabetes .
出处
《中华脑科疾病与康复杂志（电子版）》
2014年第6期26-30,共5页
Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）
