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目的探讨肢端肥大症合并甲状腺疾病的临床特点及相关危险因素。方法严格按照纳入及排除标准选取93例初诊初治的肢端肥大症病人,均行甲状腺超声检查,诊断标准使用TI-RADS评价系统。临床资料的相关性采用多重线性回归分析,危险因素分析采用二分类Logistic回归。结果 72例(77.4%)合并甲状腺疾病设为甲状腺异常组,其中良性69例,恶性3例;余21例设为甲状腺正常组。多重线性回归分析表明:甲状腺体积与生长激素随机值(P=0.002)、生长激素谷值(P=0.005)及胰岛素样生长因子1(IGF-1)值(P=0.004)均呈线性相关;T3水平与IGF-1值呈正相关关系(P<0.05)。甲状腺异常组比甲状腺正常组具有更高的GH负荷水平(P<0.05)。多因素Logistic回归分析表明:年龄是肢端肥大症病人合并甲状腺疾病的独立危险因素(P=0.002)。结论与正常人群相比,肢端肥大症病人合并甲状腺良、恶性疾病的风险均显著提高,且年龄是其独立危险因素;甲状腺体积、功能与异常升高的生长激素、IGF-1密切相关。临床医师应做好肢端肥大症合并症的早期评估和规范化诊疗,重视术后的内分泌学治愈。
Objective To investigate the clinical characteristics and related risk factors of acromegaly with thyroid disease. Methods Ninety-three patients with newly diagnosed acromegaly were selected strictly according to inclusion and exclusion criteria. Thyroid ultrasonography was performed. The diagnostic criteria was TI-RADS evaluation system. The correlation of clinical data was analyzed by multiple linear regression and the risk factors were analyzed by binary Logistic regression. Results 72 cases (77.4%) with thyroid disease were set as abnormal thyroid group, including 69 cases of benign and 3 cases of malignant. The remaining 21 cases were set as normal thyroid group. Multiple linear regression analysis showed that there was a linear correlation between the thyroid gland volume and the values of growth hormone (P = 0.002), growth hormone (P = 0.005) and IGF-1 (P = 0.004) The level of T3 was positively correlated with IGF-1 (P <0.05). The abnormal thyroid group had a higher GH load level than the normal thyroid group (P <0.05). Multivariate Logistic regression analysis showed that age was an independent risk factor for thyroid disease in patients with acromegaly (P = 0.002). Conclusion Compared with the normal population, the patients with acromegaly have significantly higher risk of benign and malignant thyroid diseases, and age is an independent risk factor. The thyroid volume and function are closely related to abnormally elevated growth hormone and IGF-1. Clinicians should do a good job of acromegaly complications and early diagnosis and standardization of diagnosis and treatment, emphasis on postoperative endocrinology cure.