中华脑科疾病与康复杂志（电子版）
中華腦科疾病與康複雜誌（電子版）
중화뇌과질병여강복잡지（전자판）
CHINESE JOURNAL OF BRAIN DI8SEASES AND REHABILITATIN(ELECTRONIC EDITION)
2014年
6期
26-30
,共5页
孔令胜%姚维成%栗世方%贺昭忠%成磊
孔令勝%姚維成%慄世方%賀昭忠%成磊
공령성%요유성%률세방%하소충%성뢰
肢端肥大症%糖尿病%促甲状腺素%分泌生长激素的垂体腺瘤%发病机制
肢耑肥大癥%糖尿病%促甲狀腺素%分泌生長激素的垂體腺瘤%髮病機製
지단비대증%당뇨병%촉갑상선소%분비생장격소적수체선류%발병궤제
Acromegaly%Diabetes%Thyrotropin%Growth hormone-secreting pituitary adenoma%Pathogenesis
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。
目的：比較分析繼髮與不繼髮糖尿病的肢耑肥大癥型垂體腺瘤患者的臨床資料，初步探討肢耑肥大癥垂體腺瘤繼髮糖尿病的可能病理免疫學機製。方法迴顧性分析2008年1月至2013年6月濟寧醫學院附屬醫院神經外科採用單鼻孔直達蝶竇入路顯微手術切除的84例肢耑肥大癥垂體腺瘤患者的臨床資料，運用免疫化學髮光法測定術前基礎血生長激素（ GH）水平，使用多田公式（ xyz／2）計算MRI上腫瘤體積，採用免疫組織化學的方法檢測腫瘤內分泌激素的錶達，採用χ2或t檢驗比較繼髮與不繼髮糖尿病的肢耑肥大癥垂體腺瘤患者在髮病年齡、性彆、髮病時間、瘤體大小、基礎血GH水平以及腫瘤激素免疫反應等方麵的差異。結果20例（24％）肢耑肥大癥垂體腺瘤患者繼髮糖尿病。繼髮和不繼髮糖尿病的肢耑肥大癥垂體腺瘤患者男女均可髮病（χ2＝1.944， P ＝0.163），髮病年齡多集中在41～50歲（ P＝0.652），MRI顯示瘤體大小均有微腺瘤、大腺瘤、巨大腺瘤，差異均無統計學意義（ P＝1.000）；髮病時間分彆集中在1～5年（55％）、6～10年（45％），差異有統計學意義（P＝0.004）；術前基礎血GH水平分彆為（42.83±8.70）ng／ml、（38.91±36.46）ng／ml，差異有統計學意義（t＝5.253，P＝0.031）。繼髮糖尿病的肢耑肥大癥垂體腺瘤患者促甲狀腺激素（TSH）免疫反應平均光密度值（0.545±0.023）明顯高于不繼髮糖尿病者（0.408±0.019），差異有統計學意義（t＝5.336，P＝0.001）；TSH免疫反應暘性率（70％）亦明顯高于不繼髮糖尿病的肢耑肥大癥患者（14％），差異有統計學意義（χ2＝23.971， P＝0.000）。結論繼髮與不繼髮糖尿病的肢耑肥大癥垂體腺瘤患者在髮病年齡、性彆、瘤體大小方麵無明顯差彆，但二者在髮病時間、術前基礎血GH水平及腫瘤病理免疫反應方麵存在明顯差彆，腫瘤細胞分泌的TSH可能參與瞭肢耑肥大癥垂體腺瘤繼髮糖尿病的病理生理過程。
목적：비교분석계발여불계발당뇨병적지단비대증형수체선류환자적림상자료，초보탐토지단비대증수체선류계발당뇨병적가능병리면역학궤제。방법회고성분석2008년1월지2013년6월제저의학원부속의원신경외과채용단비공직체접두입로현미수술절제적84례지단비대증수체선류환자적림상자료，운용면역화학발광법측정술전기출혈생장격소（ GH）수평，사용다전공식（ xyz／2）계산MRI상종류체적，채용면역조직화학적방법검측종류내분비격소적표체，채용χ2혹t검험비교계발여불계발당뇨병적지단비대증수체선류환자재발병년령、성별、발병시간、류체대소、기출혈GH수평이급종류격소면역반응등방면적차이。결과20례（24％）지단비대증수체선류환자계발당뇨병。계발화불계발당뇨병적지단비대증수체선류환자남녀균가발병（χ2＝1.944， P ＝0.163），발병년령다집중재41～50세（ P＝0.652），MRI현시류체대소균유미선류、대선류、거대선류，차이균무통계학의의（ P＝1.000）；발병시간분별집중재1～5년（55％）、6～10년（45％），차이유통계학의의（P＝0.004）；술전기출혈GH수평분별위（42.83±8.70）ng／ml、（38.91±36.46）ng／ml，차이유통계학의의（t＝5.253，P＝0.031）。계발당뇨병적지단비대증수체선류환자촉갑상선격소（TSH）면역반응평균광밀도치（0.545±0.023）명현고우불계발당뇨병자（0.408±0.019），차이유통계학의의（t＝5.336，P＝0.001）；TSH면역반응양성솔（70％）역명현고우불계발당뇨병적지단비대증환자（14％），차이유통계학의의（χ2＝23.971， P＝0.000）。결론계발여불계발당뇨병적지단비대증수체선류환자재발병년령、성별、류체대소방면무명현차별，단이자재발병시간、술전기출혈GH수평급종류병리면역반응방면존재명현차별，종류세포분비적TSH가능삼여료지단비대증수체선류계발당뇨병적병리생리과정。
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 .
