摘要目的 探讨肢端肥大症患者的心房心室腔及大血管内径的变化情况及其相关危险因素.方法 选取2013年1至12月在北京协和医院神经外科确诊为肢端肥大症的92例患者(试验组),其中男37例,女55例,年龄19 ～67(41±13)岁,并根据试验组性别、年龄选取92例健康体检者作为对照组,采集两组患者相关病史、超声心动图及内分泌激素检查等信息进行对比分析,并采用二元logistic回归分析筛选与发生大血管内径扩大相关的危险因素,得出OR值及预测模型.结果 试验组患者的左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、左房前后径(LALD)、右室前后径(RVLD)、主动脉根部内径(AORD)、升主动脉内径(AA)及主肺动脉内径(MPA)均较对照组有明显扩大,P ＜0.05;其中试验组的大血管内径扩大者(ADE)与内径正常者的病程(月)对比差异有统计学意义(121 ±70比73±59,P＜0.05,OR=1.011),建立回归方程为:logit (ADE)=-3.420 +0.011×病程.结论 肢端肥大症患者心腔及大血管内径较正常人有扩大,其中大血管内径扩大与病程长短有关,与GH、IGF-1高低无关,病程时间长是其危险因素.

abstractsObjective To investigate alternations of heart cavity and great vessel diameters and their risk factors in acromegalic patients.Methods Ninety-two cases,diagnosed as acromegaly,were selected as research subjects from January 2013 to December 2013 in Peking Union Medical College Hospital.There were 37 males and 55 females with an average age of 41.2 years (SD,12.5 years,range from 19 to 67 years old).Ninety-two sex and age matched healthy individuals were selected as controls.Disease history,echocardiography,endocrine hormone levels were collected to make contrastive analysis.We analyzed the related risk factors of great vessel diameters expansion with binary logistic regression analysis and finally obtained the OR (odd ratio) and predictive formula.Results Left ventricle enddiastolic diameter (LVEDD),left ventricle end-systolic diameter (LVESD),left atrium longitudinal dimension (LALD),right ventricle longitudinal dimension (RVLD),aortic root dimension (AORD),ascending aorta (AA),main pulmonary artery (MPA) were higher in patients with acromegaly than in healthy people,P ＜ 0.05.The comparison between expanded vessel diameters and normal vessel diameters in acromegalics showed that difference of disease duration was of statistical significance,OR =1.011.We got the formula:logit (ADE) =-3.420 + 0.011 × duration of disease.Conclusion Heart cavity and vessel diameters in acromegalic patients were higher than that in public.Expanding of great vessel diameters mainly depend on duration of disease instead of serum GH and IGF-1 level,and the duration of disease is the risk factor of the expansion of great vessel diameters.