目的:GH/IGF-1水平对肢端肥大症骨骼肌的影响仍存在争议。时间(TMT)和咬肌(MMT)厚度最近已被证明是肌肉质量的可靠量度。我们的目的是调查TMT之间的关系,肢端肥大症患者的MMT和临床/生化特征。
方法:单中心回顾性纵向研究,包括69例患者,至少有一个可用的脑/蝶鞍MRI和匹配的临床数据。TMT,MMT,和肌肉脂肪浸润(改良Goutallier评分)在基线(首次可用MRI)和随时间(182MRI分析)对所有患者进行评估.
结果:在基线时,男性的TMT和MMT均高于女性(分别为p=0.001和p=0.016)。TMT和MMT呈正相关(β0.508,p<0.001),它们与IGF-1xULN(TMT,p=0.047;MMT,p=0.001)。MMT与患者体重(p=0.015)和身高(p=0.006)呈正相关。TMT之间没有发现相关性,MMT和性腺机能减退的存在。考虑到所有可用的MRI,在多变量分析中,性别和IGF-1xULN是TMT和MMT的重要决定因素(女性:β-0.345/-0.426,p<0.001;IGF-1xULN:β0.257/0.328,p<0.001)。在纵向评估时,基线时不受控制的患者显示MMT随时间显著降低(p=0.044)。在34-37%的MRI中观察到明显的脂肪浸润;年龄是主要决定因素(颞肌:OR1.665;p=0.013;咬肌:OR1.793;p=0.009)。
结论:IGF-1值较高的男性患者颞肌和咬肌较厚,表明性别和IGF-1对肢端肥大症的肌肉质量有显著影响。
OBJECTIVE: The impact of GH/IGF-1 levels on skeletal muscle in acromegaly is still controversial. Temporal (TMT) and masseter muscle (MMT) thickness has been recently demonstrated as a reliable measure of muscle mass. We aimed to investigate the relationship between TMT, MMT and clinical/biochemical characteristics in patients with acromegaly.
METHODS: Single center retrospective longitudinal study including 69 patients with at least one available brain/sella turcica MRI and matched clinical data. TMT, MMT, and muscle fatty infiltration (modified Goutallier score) were evaluated in all patients at baseline (first available MRI) and over time (182 MRIs analyzed).
RESULTS: At baseline, both TMT and MMT were higher in males than females (p = 0.001 and p = 0.016, respectively). TMT and MMT were positively associated (β 0.508, p < 0.001), and they were positively correlated with IGF-1 xULN (TMT, p = 0.047; MMT, p = 0.001). MMT had a positive correlation with patients\' weight (p = 0.015) and height (p = 0.006). No correlation was found between TMT, MMT and the presence of hypogonadism. Considering all available MRIs, sex and IGF-1 xULN were significant determinants of TMT and MMT at multivariable analysis (female sex: β -0.345/-0.426, p < 0.001; IGF-1 xULN: β 0.257/0.328, p < 0.001). At longitudinal evaluation, uncontrolled patients at baseline showed a significant reduction of MMT over time (p = 0.044). Remarkable fatty infiltration was observed in 34-37% of MRIs; age was the main determinant (temporal muscle: OR 1.665; p = 0.013; masseter muscle: OR 1.793; p = 0.009).
CONCLUSIONS: Male patients with higher IGF-1 values have thicker temporal and masseter muscles, suggesting that sex and IGF-1 have a significant impact on muscle mass in acromegaly.