【摘要】 目的 探讨血清胰岛素样生长因子-1(Insulin-like growth factor,IGF-1)升高可能存在的原因。方法 回顾性分析2014年1月-2020年12月新疆维吾尔自治区人民医院血清IGF-1升高的272例患者的临床特征。结果 272例患者中男女比例为1∶1.37，既往手术治疗病理明确诊断为生长激素细胞腺瘤患者79人，193人为初次入院筛查，两组在肿瘤直径、微腺瘤及大腺瘤占比上不存在差异；分析两组患者肢端肥大症的临床表现及合并症发现，肢端肥大症状在既往明确诊断患者中更为常见。根据初次入院筛查患者行鞍区MRI或CT检查发现垂体占位并在神经外科行经鼻蝶入路手术治疗有53人，无垂体占位的有21人。术后免疫组化分析提示生长激素细胞腺瘤46例，促肾上腺皮质激素细胞腺瘤3例，零细胞腺瘤、多激素腺瘤、泌乳素腺瘤及促性腺激素腺瘤各1例，根据IGF-1升高程度，影像学发现垂体占位的IGF-1较无占位升高明显。21例无垂体占位患者中1例提示垂体形态饱满，4例提示空泡蝶鞍，剩余16例未见明显临床症状及肢端肥大症相关合并症。结论 对于IGF-1升高不明显、垂体影像学及评估合并症未见异常的患者，诊断为肢端肥大症的可能性不大，不排除存在参考范围不匹配、血清IGF-1水平的正常参考范围上限被低估等可能。需要长期对这部分患者进行随访并加大对肢端肥大症的科普力度。更多还原

【Abstract】 Objective To explore the possible reasons for the increase of serum insulin-like growth factor-1(IGF-1). Methods The clinical characteristics of 272 patients with elevated serum IGF-1 in People’s Hospital of Xinjiang Uygur Autonomous Region from January 2014 to December 2020 were analyzed retrospectively. Results The male to female ratio of 272 patients was 1.37. 79patients were diagnosed as growth hormone cell adenoma by operation and pathology, and 193 patients were screened for the first time.There was no difference in tumor diameter, the proportion of microadenoma and macroadenoma between the two groups. Analysis of the clinical manifestations and complications of acromegaly between the two groups showed that acromegaly was more common in patients with definite diagnosis. According to the MRI or CT examination of Sellar region, 53 patients with pituitary mass were treated by transsphenoidal approach in neurosurgery, and 21 patients without pituitary mass. Postoperative immunohistochemical analysis showed that there were 46 cases of growth hormone cell adenoma, 3 cases of adrenocorticotropin cell adenoma, 1 case of zero cell adenoma, 1case of polyhormone adenoma, 1 case of prolactin adenoma and 1 case of gonadotropin adenoma. according to the elevated degree of IGF-1, imaging showed that the IGF-1 of pituitary mass was significantly higher than that of non-space occupying pituitary. Among the 21 patients without pituitary mass, 1 case showed full pituitary shape, 4 cases showed empty Sella turcica, and the remaining 16cases had no obvious clinical symptoms and acromegaly-related complications. Conclusion For the patients with no obvious increase of IGF-1 and no abnormality in pituitary imaging and evaluation of complications, the possibility of diagnosis of acromegaly is not great,and the mismatch of reference range and the underestimation of the upper limit of normal reference range of serum IGF-1 level can not be ruled out. It is necessary to follow up these patients for a long time and strengthen the science popularization of acromegaly.更多还原