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目的探讨肢端肥大症患者生长激素(GH)和胰岛素样生长因子1(IGF-1)负荷与心脏结构和功能改变的关系。方法回顾性分析99例肢端肥大症患者的临床资料,依据超声心动图检查结果,将患者分为参数异常组和正常组。采用Pearson相关性分析,探究患者的病程、平均GH、平均IGF-1、GH负荷、IGF-1负荷与超声心动检查中各项与心脏结构和功能有关参数的相关性。结果共有48例(48.5%)患者超声心动图存在异常,包括心腔扩大(29.3%)、瓣膜病变(15.1%)、主动脉根部增宽(5.1%)、左室收缩或舒张功能异常(19.2%)、室壁运动异常(1.0%)。参数异常组(n=48)的平均GH负荷普遍高于正常组(n=57),但仅左室收缩末内径(LVESD)与正常组差异有统计学意义(P=0.018);平均IGF-1负荷也普遍高于正常组,但仅二尖瓣口血流频谱峰值血流速度比值(E/A)(P=0.011)、左房前后径(LALD)(P=0.017)与正常组差异有统计学意义。将患者按照超声心动图诊断的舒张功能下降与否分为正常组(n=81)和异常组(n=18),正常组的GH负荷与异常组差异无统计学意义(P=0.419),而IGF-1负荷异常组高于正常组(P=0.018)。GH负荷与左室舒张末内径(LVEDD)、LVESD之间存在相关性(P<0.05),IGF-1负荷与左心室射血分数(LVEF)、LALD、右室前后径(RVLD)、左室后壁厚度(LVPWT)、LVEDD、LVESD、E/A这7项参数之间存在相关性(P<0.05)。结论 GH、IGF-1负荷可为评估肢端肥大症患者心血管系统并发症提供更好的评价指标。
Objective To investigate the relationship between cardiac structural and functional changes of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) load in patients with acromegaly. Methods The clinical data of 99 patients with acromegaly were retrospectively analyzed. According to the results of echocardiography, the patients were divided into abnormal parameter group and normal group. Pearson correlation analysis was used to investigate the patient’s course, mean GH, mean IGF-1, GH burden, IGF-1 load, and echocardiographic correlation with cardiac structure and function-related parameters. Results A total of 48 patients (48.5%) had abnormal echocardiography including enlarged heart cavity (29.3%), valvular disease (15.1%), aortic root widening (5.1%), left ventricular systolic or diastolic dysfunction %), Abnormal wall motion (1.0%). The mean GH load of the abnormal parameter group (n = 48) was generally higher than that of the normal group (n = 57), but the difference between LVESD and normal group was statistically significant (P = 0.018) 1 load was also generally higher than that of the normal group, but only the ratio of peak flow velocity (E / A) (P = 0.011), LALD (P = 0.017) There is statistical significance. The diastolic dysfunction in patients diagnosed by echocardiography was divided into normal group (n = 81) and abnormal group (n = 18). There was no significant difference between normal group and normal group (P = 0.419) The abnormal IGF-1 load group was higher than the normal group (P = 0.018). The correlation between GH load and left ventricular end-diastolic diameter (LVEDD), LVESD (P <0.05), IGF-1 load and left ventricular ejection fraction (LVEF), LALD, RVLD, LVPWT, LVEDD, LVESD and E / A were significantly correlated with each other (P <0.05). Conclusion The GH and IGF-1 load may provide a better evaluation index for assessing cardiovascular complications in patients with acromegaly.