Abstract：
OBJECTIVE: To investigate the impact of pituitary surgery on glucose metabolism and to identify predictors of remission of diabetes after pituitary surgery in patients with acromegaly.
METHODS: A national multicenter retrospective study of patients with acromegaly undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study) was performed. Surgical remission of acromegaly was evaluated according to the 2000 and 2010 criteria.
RESULTS: A total of 604 acromegaly patients were included in the study with a total median follow up of 91 months (interquartile range [IQR] 45-163). At the acromegaly diagnosis, 23.8% of the patients had diabetes mellitus (DM) with a median glycated hemoglobin (HbA1c) of 6.9% (IQR 6.4-7.9) [51.9 mmol/mol (IQR 46.4-62.8)]. In the multivariate analysis, older age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), dyslipidemia (OR 5.25, 95% CI 2.81 to 9.79), arthropathy (OR 1.39, 95% CI 2.82 to 9.79), and higher IGF-I levels (OR 1.30, 95% CI 1.05 to 1.60) were associated with a greater prevalence of DM. At the last follow-up visit after surgery, 21.1% of the DM patients (56.7% of them with surgical remission of acromegaly) experienced diabetes remission. The cure rate of DM was more common in older patients (hazard ratio [HR] 1.77, 95% CI 1.31 to 2.43), when surgical cure was achieved (HR 2.10, 95% CI 1.01 to 4.37) and when anterior pituitary function was not affected after surgery (HR 3.38, 95% CI 1.17 to 9.75).
CONCLUSIONS: Glucose metabolism improved in patients with acromegaly after surgery and 21% of the diabetic patients experienced diabetes remission; being more frequent in patients of older age, and those who experienced surgical cure and those with preserved anterior pituitary function after surgery.
METHODS: A national multicenter retrospective study of patients with acromegaly undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study) was performed. Surgical remission of acromegaly was evaluated according to the 2000 and 2010 criteria.
RESULTS: A total of 604 acromegaly patients were included in the study with a total median follow up of 91 months (interquartile range [IQR] 45-163). At the acromegaly diagnosis, 23.8% of the patients had diabetes mellitus (DM) with a median glycated hemoglobin (HbA1c) of 6.9% (IQR 6.4-7.9) [51.9 mmol/mol (IQR 46.4-62.8)]. In the multivariate analysis, older age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), dyslipidemia (OR 5.25, 95% CI 2.81 to 9.79), arthropathy (OR 1.39, 95% CI 2.82 to 9.79), and higher IGF-I levels (OR 1.30, 95% CI 1.05 to 1.60) were associated with a greater prevalence of DM. At the last follow-up visit after surgery, 21.1% of the DM patients (56.7% of them with surgical remission of acromegaly) experienced diabetes remission. The cure rate of DM was more common in older patients (hazard ratio [HR] 1.77, 95% CI 1.31 to 2.43), when surgical cure was achieved (HR 2.10, 95% CI 1.01 to 4.37) and when anterior pituitary function was not affected after surgery (HR 3.38, 95% CI 1.17 to 9.75).
CONCLUSIONS: Glucose metabolism improved in patients with acromegaly after surgery and 21% of the diabetic patients experienced diabetes remission; being more frequent in patients of older age, and those who experienced surgical cure and those with preserved anterior pituitary function after surgery.
摘要：
目的：探讨垂体手术对肢端肥大症患者糖代谢的影响及垂体手术后糖尿病缓解的预测因素。
方法：对西班牙33家三级医院首次接受经蝶手术的肢端肥大症患者进行了一项国家多中心回顾性研究（ACRO-SPAIN研究）。根据2000年和2010年标准评估肢端肥大症的手术缓解。
结果：共604例肢端肥大症患者纳入研究，总的中位随访时间为91个月（四分位距[IQR]45-163）。在肢端肥大症诊断时，23.8%的患者患有糖尿病（DM），糖化血红蛋白（HbA1c）中位数为6.9%（IQR6.4-7.9）[51.9mmol/mol（IQR46.4-62.8）]。在多变量分析中，年龄较大(比值比[OR]1.02，95%CI1.00-1.05)，血脂异常（OR5.25，95%CI2.81至9.79），关节病（OR1.39，95%CI2.82至9.79），和较高的IGF-I水平（OR1.30，95％CI1.05至1.60）与更高的DM患病率相关。在手术后的最后一次随访中，21.1％的DM患者（其中56.7％的肢端肥大症手术缓解）经历了糖尿病缓解。糖尿病的治愈率在老年患者中更为常见(风险比[HR]1.77,95%CI1.31~2.43),当达到手术治愈时(HR2.10,95%CI1.01~4.37),当手术后垂体前叶功能未受影响时(HR3.38,95%CI1.17~9.75).
结论：肢端肥大症患者术后血糖代谢得到改善，21%的糖尿病患者糖尿病缓解；年龄较大的患者更常见，以及那些经历了手术治愈的人和那些在手术后保留了垂体前叶功能的人。
方法：对西班牙33家三级医院首次接受经蝶手术的肢端肥大症患者进行了一项国家多中心回顾性研究（ACRO-SPAIN研究）。根据2000年和2010年标准评估肢端肥大症的手术缓解。
结果：共604例肢端肥大症患者纳入研究，总的中位随访时间为91个月（四分位距[IQR]45-163）。在肢端肥大症诊断时，23.8%的患者患有糖尿病（DM），糖化血红蛋白（HbA1c）中位数为6.9%（IQR6.4-7.9）[51.9mmol/mol（IQR46.4-62.8）]。在多变量分析中，年龄较大(比值比[OR]1.02，95%CI1.00-1.05)，血脂异常（OR5.25，95%CI2.81至9.79），关节病（OR1.39，95%CI2.82至9.79），和较高的IGF-I水平（OR1.30，95％CI1.05至1.60）与更高的DM患病率相关。在手术后的最后一次随访中，21.1％的DM患者（其中56.7％的肢端肥大症手术缓解）经历了糖尿病缓解。糖尿病的治愈率在老年患者中更为常见(风险比[HR]1.77,95%CI1.31~2.43),当达到手术治愈时(HR2.10,95%CI1.01~4.37),当手术后垂体前叶功能未受影响时(HR3.38,95%CI1.17~9.75).
结论：肢端肥大症患者术后血糖代谢得到改善，21%的糖尿病患者糖尿病缓解；年龄较大的患者更常见，以及那些经历了手术治愈的人和那些在手术后保留了垂体前叶功能的人。
