垂体疾病及治疗

垂体疾病及治疗 第三　巨人症和肢端肥大症　　节节节节节节节节节节节节节 巨人症，,,,,,,,,,,和肢端肥大症，,,,:,,,,，,,皆因生激素节节节，,,,分泌多所致。,,多生在青春期前骨部未合者可节节节节节节节节节节节节节节节节节节节节节节节节致骨向生度,巨人症,如病于青春期后,骨节节节节节节节节节节节节节节节节节节节节节节节节节节节 部已合,骨的向生受限,表肢端肥大症。巨人症者节节节节节节节节节节节节节节节节节节节节节节节节节节 在入成年后如未有效治,受,,的度刺激,也可出节节节节节节节节节节节节节节节节节节节节节节节节节节节节 肢端肥大症的表,称肢端肥大性巨人症。大多数巨人症和节节节节节节节节节节节节节节节节节节节节节肢端肥大症由垂体疾病，主要是垂体,,胞瘤,引起,称垂体性巨人症节节节节节节节节节节节节节节节，,,,,,,,,,,,,,,,,,,,和垂体性肢端肥大症，,,,,,,,,, ,,,,:,,,,，,,。【病因与病机制】　,,,,,,,,,年道两,节节节节节节节节节节节节节节节节节节节例肢端肥大症病人伴有垂体瘤,垂体瘤肢端肥大症的表的一节节节节节节节节节节节节节节节节节节节节部分,但当并不清楚是垂体的高分泌致了肢端肥大症。已清楚,节节节节节节节节节节节节节节节节节节节节节节节节节节垂体,,胞瘤肢端肥大症最主要的原因。去,,胞节节节节节节节节节节节节节节节节节节节节节节节节 瘤系下丘生抑素及,,节节节节节节节节节节节节节节节节节节节节节,,分泌失所致。近年研究, 表明,大多数,,胞瘤的原病因在,,胞本身。节节节节节节节节节节节节节节节节节节节节节节节 ,:,的,,胞瘤的瘤胞有,,节节节节节节节节节节α基因的突,果使得腺苷酸化节节节节节节节节节节节节持地于激活状,胞内,,,,水平持性升高,于节节节节节节节节节节节节节节节节节节节节节节节节节 是胞持地增生,乃形成腺瘤。下丘功能紊乱及下丘节节节节节节节节节节节节节节节节节节节节节节节节节 ,,,,瘤可使,,,,生多,引起垂体,,胞增生,久之节节节节节节节节节节节节节节节节节节可形成,,胞瘤,生肢端肥大症。同异位,,,,区,节节节节节节节节节节节节节节节节节节节节节节节 下丘生的,,,,也称正位,,,,，,,,:,,,,节节节节节节节节节节节节节节节节节节节节节节节节节节 ,,,,。异位,,,,亦可引起垂体,,胞增生乃至形成,,胞瘤。,,节节节节节节节节节节节节节节节节节胞癌和异位,,胞瘤亦可引起肢端肥大症,二者均极罕,其病因亦不明了。节节节节节节节节节节节节节节节节节节节节节节节节节节节肢端肥大症可作,型多性内分泌腺瘤　，,,,,,的表节节节节节节节节节节节节节节节节节节节节节之一。有肢端肥大症表的,,节节节节节节节节节节节节节节节,,,,,，,,,,,,,,合征病人的垂体在病理上可以,,胞的增生,也可腺瘤。已明节节节节节节节节节节节节节节节节节节确,,,,,,,,，,,,,,,合征乃,,,节节节节节节α节节节节节节节节位基因的体胞突所致,节节节节节节节节节节节节节节节节节节节节节节节节节节节节就不理解何以合征会出,,胞的增生或腺瘤。近年有研 究示,部分肢端肥大症病人血液含有具,,活性的抗,,受体抗体,此抗,,受抗体节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节在肢端肥大症病中的作用未明。巨人症的病因与肢端肥大症相似。上,凡能引起肢节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节端肥大症的病均可引起巨人症,二者主要的区在于起病年的不同。【床表】　,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,肢端肥大症　肢端肥大症的床表主要由,,多引起,此外,瘤迫垂体、瘤侵入节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节近亦可生相的表。，,,,,多症群?皮及骨表:,,多可刺 激全身皮、胞的增生,以及糖胺聚糖、透明酸、硫酸骨素、硫酸皮素等基节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节成分的沉。患者全身皮增厚、粗,面部尤明,皮可形成褶。皮附属器官亦节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节可有明改,皮脂腺肥大,且分泌增加,使患者皮得节节节节“节”油。汗腺亦肥大,故出汗增加。 毛囊大,汗毛增加,但可因脱落而稀疏。部分病人节节节节节节节节节节节节节节节节节节节节节节节 可有黑棘皮病。增生症状常很突出,病人嘴唇增厚,舌节节节节节节节节节节节节节节节节节节节节 肥大,喉增大,腭增厚。声常增厚、增,使病人声节节节节节节节节节节节节节节节节节节节节节节节 低沉,女性出男声。部分病人的正中神可因的增生而节节节节节节节节节节节节节节节节节节节节节节 受,生腕节节节节节节节节节节节节节节节节节节节节节节节节节节管合征。,,多骨骼可生重的影响,尤以骨节节节节节节节节节节节节节节节节节节节节节节节节节节著。患者骨增生厚,同面部亦增生, 使得大。骨增生多很明,同大,节节节节节节节节节节节节节节节节节节节节节节节节节节节眶上突出。节节节节节节节节节节节节节节节节节节节节节节节节骨增大,弓突出。下骨增增,使牙得稀疏,下前凸。当嘴合,下与上并节节节节节节节节节节节节节节节节节节节节节节节节节列甚至于上之前,形成节节节节节节节节节节节节节节节节节节节节节节节节节节节节位咬合。有出炎。鼻骨亦增厚,同因鼻部皮节节节节节节节节节节节节节节节节节节节节节节节的增生,使鼻增大。病程者上述面部表多很突出,一即留下深刻印象,即所肢端肥大症面节节节节节节节节节节节节节节节节节节节节节节节节节容。指骨和趾骨常明增生,加之些部位皮亦有增生,使病人节节节节节节节节节节节节节节节节节节节节节节节节节节节节节手足大,其手套、鞋袜的尺大,病人从事精节节节节节节节节节节节节节节节节节节节节节节节活的能力下降,如以从地上或桌上起。部分病人有手指僵直感。椎骨常增大增,、节节节节节节节节节节节节节节节腰部椎常增厚,胸椎椎薄节节节节节节节节节节节节节节节节节节节节节节节节节节节节节。椎旁常肥大、松弛。椎孔周的骨增生可迫神节节节节节节节节节节节节节节节节节节节节节节节节节根而引起感异常及神根性疼痛。患者肋骨可增,加之胸椎后凸,使胸部前后径增大,形成桶状胸。节节节节节节节节节节节节节节节量的,,不使循胰素生节节节节节节节节节因子,,,,，,,,?,水平增加,而且使局部,,,?节节节节节节节节节节节节节节节节节节节节节节节节节节生多,使得骨胞增生活、合成及分泌功能旺盛,最致基合成多,于是骨厚,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节腔,最 形。,,同刺激节节节节节节节节节节节节节节节节节节节节节节节节节节节周的增生,致增厚、松弛,滑膜肥大,使得骨节节节节节节节节节节节节节节节节节节节节节节节节磨加重,久之骨表面可出裂隙,在此基上可形成节节节节节节节节节节节节节节节节节节节节节节节节节节节节节新生骨。新生骨可出骨化,从而生骨节节节节节节节节节节节节节节节节节节节节节节节节节节节。重病例骨表面的裂隙可深至骨下并不断增,从而在骨表面生。节节节节节节节节节节节节节节节节节节节节节节节节节节节节节膝最易受累,其次、肩,肘、踝、指，趾,节节节节节节节节节节节节节节节节节节节节节节节节节节节节少受累。多数病人的腔大,骨增厚。病程久者骨节节节节节节节节节节节节节节节节节节节节节节节节节节节出,出液的渗渗薄,腔窄。少数病人有 节节节节节节节节节节节节节节节节节节节节节节节节节节节节节示非炎症性病。疼痛最常的症状,于::,的病人。节节节节节节节节节节节节节节节节节节节节节节节节节节节疼痛常歇性,活后加重。体常可听到捻音，,,,,,,,,,,节节节节节节节节节节节节节节节节节节节节节僵硬和也很常。一些病人的症状可很突出而影响其体力活。皮、及骨的改与血,,及节节节节节节节节节节节节节节节节节节节节节,,,?,,水平呈正相,治后节节节节节节节节节节节节节节节节节?水平的随着血,,及,,,下降皮、的化可改节节节节节节节节节节节节节节节节节节节节节节节节节节节善,骨病也停止展但以完全恢节节节节节节节节节节节节节节节节节节节节节节节。?内分泌代化:主要表在,个方面。甲状腺:,:,,,:,的肢端肥大症病人出节节节节节节节节节节节节节节甲状腺大,可甲状腺增生、腺瘤或增生伴腺瘤。甲状腺功能多正常,但基节节节节节节节节节节节节代率往往增高,是由于,,节节节节节节节节节节节节节节节节节节节节节节节代的促作用所致。少数病人可有甲亢,可能由于患者同节节节节节节节节节节节节节节节节节节节节节节节节节节节节节存在,,,,,,病,或患者甲状腺增生度成自主性,也可能是由于多激素型垂体腺瘤所致,瘤节节节节节节节节节节节节节节节节节节节除分泌,,外生,,,,从而致垂体性甲状腺功能亢节节节节节节节节节节节节节节节节节节节，称甲亢,。肢端肥大症可合并有突眼,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节可能是由于同存在,,,,,,病,也可能因,,增多引起眶内增生度所致,可能因垂体瘤侵节节节节节节节节节节节节节节节节节节节节节节节节节节节犯海引起静脉回流受阻所致。上腺:肢端肥大症病人上腺皮多增生肥大,节节节节节节节节节节节节节节节节节节节节节偶有腺瘤,髓一般正常。糖皮激素和皮激素的分泌多正常,女性病人的节节节节节节节节节节节节节节节节节节节节节节节雄激素生增加,使病人出男性化症状,但一节节节节节节节节节节节节节节节节节节节节节节节节节节般不重。性腺:男性病人节节节节节节节节节节节节节节节节节节节节节节节茎、囊和睾丸均增大,睾分泌增加,使病人性欲亢节节节节节节节节节节节节节节节节节节节节节节节节节节节,但精子数目和活力下降,故生育力降低。女性病人的唇肥厚,节节节节节节节节节节节节节节节节节节节节大多蒂增大,道、萎巢子、卵管亦增大,但卵节节节节节节节节节节节节节节节节节节节节节,病人常有月紊乱，如,,亦无排卵,故不能生育。女性病人性欲多减退。糖代节节节节节节节节节节节节节节节节节:,,可抗胰素的作用,故肢端肥大症病人常有糖代节节节节节节节节节节节节节节节节节节紊乱。,:,,,:,的病人有糖耐量异常,性糖节节节节节节节节节节节节节节节节节节节节节节尿病亦不少，,:,,,:,,。糖尿病可本病的节节节节节节节节节节节节节节节节节节节节节节节早期表,亦可于起病多年后出。肢端肥 大症引起的糖尿病性糖节节节节节节节节节节节节节节节节节节节节尿病。病人有明的受体前性胰素抵抗,血胰节节节节节节节节节节节节节节节节节节节节素水平一般高于正常,但久病者也可出,节节节节节节节节节节节节节节节节节节节节胞功能衰竭,血胰素水平下降。肢端肥大症者可合并原性糖节节节节节节节节节节节节节节节节节节节节节节节节尿病，主要,型糖尿病,,与性糖尿病不易节节节节节节节节节节节节节节节节节节节节节节节节。一般来,如血,,水平不是很高,或有效治 节节节节节节节节节节节节节节节节节节节节节,,水平下降后再生糖尿病多原性糖尿病。脂代:患者血三节节节节节节节节节节节节节节节节节节节节节节甘油水平常升高，于,:,,,:,的病人,节节节节节节节节节节节节节节节节节节节节节可能是由于肝三甘油脂和血脂蛋白脂活性下降所致。有效治后节节节节节节节节节节节节节节节节节节节节节节随着血,,水平的下降,上述二活性升高,血三节节节节节节节节节节节节节节节节节节节节节节节甘油水平亦随之降低。,,血胆固醇水平无著影响。节节节节节节节节节节节节磷代:,,可刺激,α,节节节节节节节节节化的活性,使血胆化醇水平,,,降低而,,,,,二节节节节节节节节节节节节节节节节节节节节胆化醇水平升高,于是道的吸收增加,但病人一般无高血症,原因可能是节节节节节节节节节节节节节节节节节节节节节节节尿排泄也增加。尿排泄的增加可引起尿石,于,:,的病人。,,可刺激节节节节节节节节节节节节节节节节节节节节节节节节节节节小管磷的重吸收,半数病人血磷升高。病人血,,,和降节节节节节节节节节节节节节节节节节节节节节素水平一般正常。少数合并有甲状旁腺瘤的病人可有明的节节节节节节节节节节节节节节节节节节节节节节节节节节甲状旁腺功能亢,病人上属于,,,,。?心血管等系的化:肢端肥大症的节节节节节节节节节节节节节节节节节节节节节节心血管表可极突出,并本病最常的节节节节节节节节节节节节节节节节节节节节节节节节死亡原因。,,,,,,,的病人合并有高血,高血与节节节节节节节节节节节节节节节节节节节节节节节节节节节潴留、胞外液容量、交感神系度节节节节节节节节节节节节节节节节节节节节节节节节节有。因胞外液血管,素容量增加、潴留,故素 ,节节节节节节节节节节节节节节节节节节节节节节节节节节固系活性降低。体内量与血,,水平相,故节节节节节节节节节节节节节节节节节节节节节节节节节潴留可能是量,,作用的果。近年的研究表明,,,胞的 节节节节节节节节节节节节节节节节节节节节节节节节节节运有直接的影响。得注意的是,,,与血水平之无相系,其原因未明。合并心节节节节节节节节节节节节节节节节节节节节节节节节疾病的亦很常。左室肥厚、大于,:,的病 人,但左室病与血,,和节节节节节节节节节节节节节节节节?水平之的相性很,,,差。,:,,的病人心节节节节节节节节节节节节节节节节节节节节节节节节有异常,常的有:,,段和,波的化、左室高节节节节节节节节节节节节节节节节节节节节节节节节节节节、房室阻滞、左或右束支阻滞、早搏等。肢端肥大症病人易节节节节节节节节节节节节节节节节节节节节节节节节节节节节生冠心病,原因未明,可能与胰素抵抗、血脂异常、,,和,,,?,刺激节节节节节节节节节节节节节节节节节节节节脉平滑肌胞增殖等有。在有左室病的病人中有相当一部分并无高血,节节节节节节节节节节节节节节节节节节节节冠脉造影亦不能冠心病的存在,些病人于,,水平下降后左室病节节节节节节节节节节节节节节节节节节节节迅速改善,此病人的左室病可能,,的直接作用。另一些病人于,,水平下降后左室病节节节节节节节节节节节节节仍无明改善,此病人的左室病可能于高血、节节节节节节节节节节节节节节节节节节节节节节节节冠心病。有人将,,直接作用于心节节节节节节节节节节节节节节节节节节节节节,引起的病称肢端肥大性,心肌病，,,,:,,,，,,,,,,,:,,:,,,,,,,其病理特点是心肌节节节节节节节节节节节化和淋巴核胞的浸节节节节节节节节节节节节节节节节节节节节节节节节节节节节,,,水平下降后可恢,但也有人否此病的存在。呼吸系并症是肢端肥大症节节节节节节节节节节节节节节节节节节节节节节节另一重要死亡原因。本病患者肺节节节节节节节节节节节节节节节节节节节节节节节节可大,肺容量增加。气道狭窄是肢端肥大症极突出的表,可能由于,,节节节节节节节节节节节节节节节节节节节节节节节节节气管、支气管的直接作用所致。狭窄节节节节节节节节节节节节节节节节节节节节节节节节重于可生睡眠每窒息出。,感染可使呼吸道阻塞 症状加重,引起呼吸困节节节节节节节节节节节节节节节节节节和喘。部分病人可出阻塞性睡眠窒息节节节节节节节节节节节节节节节节节节节节节节合征，:,,,,,,,,,,,，,,,,,,,,,,,,,:,,,,其表有节节节节节节节节节节节节节节节白天睡眠增加、性打鼾、睡眠窒息节节节节节节节节节节节节节节节节节节节节节节节。此合征好于男性,其生与肥大的舌脱 垂凸入气道及喉咽部增生使喉节节节节节节节节节节节节节节节节节节节咽部狭窄有。,,水平降低后此合征不能上解。病人的节节节节节节节节节节节节节节节节节节节节节节节胃道、肝、、脾等内多增大。肢端肥大症病人的节节节节节节节节节节节节节节节节节节节节节节节肌肉多达,但病人仍感乏力、疲节节节节节节节节节节节节节节节节节节节节节节节,有人与肢端肥大性肌病有。半数病人在就节节节节节节节节节节节节节节节节节节节节节节节节节即出近端肌病,表乏力、弱和运耐力减退。部分病人可有肌酸激升高等节节节节节节节节节节节节节节节节节节节节学异常及肌改。有些病人然没有乏力、节节节节节节节节节节节节节节节节节节节节节节弱等症状,但肌已有改。在病理上可,型的肥大和节节节节节节节节节节节节节节节节节节节节节节节节,型的萎。血,,水平下降后大多数病人的肌肉症状和肌节节节节节节节节节节节节节节节节节节表能得到改善。肢端肥大症病人常有周节节节节节节节节节节节节节节节节节节节节节节节节节节神病,半数病人在就即出四肢感异常。上肢感节节节节节节节节节节节节节节节节节节节节节节节节节节异常多因增生迫正中神生腕管合征所致,或因尺神受所致,节节节节节节节节节节节节节节节节节节节节节节感异常于血,,水平下降后可恢。很多病人有抑郁症,表节节节节节节节节节节节节节节节节节节节情感淡漠、郁、主性降低、嗜睡等。由于很多病人同节节节节节节节节节节节节节节节节节节节节存在性腺功能不足,故上述表到底,,节节节节节节节节节节节节节节节节节节节节节多所致抑或性腺功能不足所致,尚肯定。肢端肥大症病人节节节节节节节节节节节节节节节节节节节节节节节节息肉的病率明增加,于,,,,,,,的病人。癌的病节节节节节节节节节节节节节节节节节节节节节节节节率也增加,于,:,的病人。，,,节节节节节节节节节节节节节节节节节节节节节节节瘤占位效引起的症状:持生的,,胞瘤可迫垂体 柄而引起高催乳素血症,瘤迫正常垂体可引起腺垂体功能节节节节节节节节节节节节节节节节节减退。腺垂体功能减退主要以相的节节节节节节节节节节节节节节节节靶腺功能减退表,包括性腺功能减退、上腺皮功能节节节节节节节节节节节节节节节节节节节节节节减退和甲状腺功能减退,其中以性腺功能减退出最节节节节节节节节节节节节节节节节节节节节节节节节节节早,症状亦最突出。神垂体有也可受累,出尿崩症,但节节节节节节节节节节节节节节节节节节节节节节节节节节少。瘤的生可引起痛。,,胞瘤亦可侵近生相的症状,如瘤侵及节节节节节节节节节节节节节节节节节节节节节节节节节节节节交叉可引起野缺、力下降,侵及下丘可生下丘合征等。，节节节节节节节节节节节节节节节节节节节节节,,其他表:有些肢端肥大症除,,增加外,合并有其节节节节节节节节节节节节节节节节节节节节节他垂体激素多,从而生相的床表。例如,合并节节节节节节节节节节节节节节节节节节节节节节节节节节,,,多者可有垂体性甲亢。在其他垂体激素中,,,,节节节节节节节节节节节节节节节节节节节节节节多最常,或者由于瘤同分泌,,,,或者由于垂体柄受。,,节节节节节节节节节节节节节节节节节节节节,多者可有溢乳,以及性腺功能减退。不有节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节些伴有溢乳的肢端肥大症未必有,,,多,些病人的溢乳症状可能系多的,,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节直接作用于,,,受体之故。肢端肥大症常表的生率如,,,,所示。,巨人症　巨人症的床表节节节节节节节节节节节节节节节节包括度生,内分泌功能紊乱,垂体瘤节节节节节节节节节节节节节节节节节节节节节节节占位效引起的症状。病孩生特迅速,其身高和体重著节节节节节节节节节节节节节节节节节节节节节节节高于同正常儿童。病者身高的增可持到,:,,:,最身高可节节节节节节节节节节节节节节节节节节节节节节达,,以上,文献道的最高身高达,:,,:,,。部分病人身体各部位的生可节节节节节节节节节节节保持正常的比例,但大多数病人肢体的增节节节节节节节节节节节节节节节节节节节节超躯干,病人成年后下半身上半身。 病程节节节节节节节节节节节节节节节节节节节节节节节节节的病人可有内增大及增生,至成年期骨合 后可出肢端肥大症的表。病人在成年以前节节节节节节节节节节节节节节节节节节节节节节节少有各并症,入成年后可出节节节节节节节节节节节节节节节节节节节节节节节节节节各并症如骨病、高血、心血管疾病、肺节节节节节节节节节节节节节节节节节节节节疾病等。巨人症罕有糖尿病,原因病人常有胰节节节节节节节节节节节节节节节节节节节节节节节节的增生,故其,胞的功能正常人增加。如未 得到有效的治,节节节节节节节节节节节节节节节节节节节节节节随着年的增病人生糖尿病的机会逐增加。疾病早期,病人的食量著节节节节节节节节节节节节节节节节增加,肌肉达,肌力增加。成年后节节节节节节节节节节节节节节节节节节节节节节节节节节节节节肌力减退,易有乏力、疲,其原因未明,有人与外周神病及节节节节节节节节节节节节节节节节节节节节节节节节节节肌病有。瘤占位效引起的症状同肢端肥大症,但 一般节节节节节节节节节节节节节节节节节节节节节节节节节。　　未治的巨人症罕能享尽天年,多于青年期即死亡。有人将肢端肥大症和巨人症的床表分两期:形成期和节节节节节节节节节节节节节节节衰退期。形成期的表主要高,,血症所致,此瘤节节节节节节节节节节节节节节节节节节节节节节占位效的表节节节节节节节节节节节节节节节节节节节节节节尚不突出,病人的精神和体力都很旺盛,入衰退期后病人的精神和体力都减退,可能是病人此已出并症,或已出腺垂体功能节节节节节节节节节节节节节节节节节节节节节节节节减退及相的靶腺功能减退症状。【影像学节节节节节节节节节节节节节节节节节节节】　瘤大者在普通,平片上即有阳性:节节节节节节节节节节节节节节节节节节节节节节节节节节蝶鞍大、鞍床被侵。,,和,,,具有重要意节节节节节节节节节节节节节节节节节节节节节节节节,,:,的病人可示不同大小的垂体腺瘤,,:,的病人表节节节节节节节节节节节节节节节节节节节节节节节节节节节节节空鞍或其他鞍部或鞍旁占位。生抑素受体像，,:,,,:,,,,,,,,,,,,:,,,,,,,,,,,,,,,技节节节节节节节在,,瘤的断中具有重要的作用。,,,,年,,,,,,,,,等首次以放射节节节节节节节节的生抑素似物,,,,,,,,,奥曲做节节节节节节节节节节节节节节节节节节生抑素受体像。但是,,,,,,,,,,奥曲节节节节节节节节节节节节节节节节节节节节节节节节节节节具有一系列缺点,如半衰期太短等,限制了它的用。随后研究人使用了一称二节节节节节节节节节节节节节节节节节节节节节节节节乙基三胺五乙酸，,,,,,,，,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,的螯合,节节,,,,,，,可与其合,且二者的和节节节节节节节节节节节节节节节节节节节节节节节力很高。携了,,,,,的,,,,可与节节节节节节节节节节节节节节节节节,,,,奥曲,合,形成,,,,,,,奥曲节节节节节节节节节节节节节节节节节,,,:,,,,,。研究表明,,，商品名:, ,,,,,,,,,,,,奥曲像节节节节节节节节节节节节节节节节,,,的效果明于,,,,奥曲节节节节节节节节节节节节节节节节节节节,。,,,,,,,,奥曲,入病人体内后可与,,,瘤的生抑素受体合,节节节节节节节节节节节节节节节节节节节节节节节节节节节节通照相以示瘤。此技不可用于,,瘤的节节节节节节节节节节节节节节节节节节节节节节节节节断中,可病人奥曲的治反:像良好的病人,奥曲节节节节节节节节节节节节节节节节节节节节节节节的效亦好。近年有人用另一螯合四氮十二节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节四乙酸，,,,,,,,,,,,，:,:,,,,,,,,,,,,,,,,,,,,,,,:,,,取代,,,,,以,:,，,节节,,代替,,,,,,形成,:,:,,,,,,,,,奥曲节节节节节节节节节节节节节节节节,:。据,道,,,,:,,, ,,,奥曲节节节节节节节节节节节节节节节节节节节节节节,的,像比,,,,,奥曲,,要好。 肢端肥大症和巨人症常累及皮、、骨、节节节节节节节节节节节节节节节节节节节节心等,在,、,,及,,,上有相的表,此不加节节节节节节节节节节节节节节节节节节节节节节节节节节节述。【室】　室断具有重要意节节节节节节节节节节节节节节节节节节节节节,,,常的,,,,,,?室,有:, ,,,功能节节节节节节节节节节节节节节节节节节节节节节节节定，,,血、尿,,定:,,呈脉冲式放,正常人血,,的峰节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节可高达,:,,,,，,其低谷可低于放射免疫，,,,,和免疫放射法，,,,,,的节节节节节节节节节节节节节节节节节节节节节节节节节节定限。肢端肥大症病人,,亦呈脉冲式放,血,,波很大,且与正常,,水平之有节节节节节节节节节节节节节节节节节节节节节重叠。因此,次血,,定肢端肥大症的节节节节节节节节节节节节节节节节节节节节节节节节节节断价极有限。有人,如基血,,在,,,,,，以下,肢端肥大症的可能性极小,若在,,,,,,,，,肢端肥大症的可能性不大,在,,,:,,,,，,节节节节节节节节节节节节节节节节节节节节节节节节节疑及肢端肥大症,在,:,,,,，以上,肢端肥大症的可能性很大。肢端肥大症的节节节节节节节节节节节节节节节节节节节节节节节断具有重要价的是血,,的多次定节节节节节节节节节节节节节节节节节节节节节,分,国外一定,般次,,,,。血,,的每多次定节节节节节节节节节节节节节节节节节节节节节节节果称血,,,能很好地反映,,,血,,的分泌情况,包括基,,水平、节节节节节节节节节节节节节节节节节节节节节节节节,,,,,整合，相当于,,的平均水平,、,,脉冲数及脉冲振幅。本症病人基,,水平正常人的,,节节节节节节节节节节节节节节,,,倍,,,,,,整合正常人的,:节节节节节节节节节节节节节节节节节节节节节节节节,,,倍,,,的脉冲数正常人的,,,倍。血,,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节固然能很好地反映机体,,的分泌情况,但其定于且以节节节节节节节节节节节节节节节节节节节节节节节病人接受。,或每,小定,次血,,,,,,,取其平均,也能节节节节节节节节节节节节节节节节,好分地反映定全,天,,的分泌情况。不,此每法上述次,,的方法节节节节节节节节节节节节节节节节节节节节节节节节但仍繁。近年有人,,,内,次特定血，上节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节午,:,:,下午,:::,下午,:::及上::::,的平 均也能节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节反映全天血,,的分泌情况,正常不超,,,,,，。另据,,，,,,,道,,节节节节节节节节节节节节节节节节节节节节节节节节节节,内,次随机血,,定的均也具有很好的断价节节节节节节节节节节节节节节节节节节节节节节节。去一般以放射免疫法，,,,,定血,,,灵敏度不高。近年主节节节节节节节节节节,,,限:采用灵敏度高的免疫放射法，,,,,,,,,,，,及化学节节节节节节节节节节节节节节节::光法,，限可,,,,,达: ，,,可以提高节节节节节节节节节节节节节节节节节节节节节节断的敏感性。注意的是,控制不佳的糖尿病、节节节节节节节节节节节节节节节节节节节节节节节节节不良、功能衰竭及激状均可使血,,水平升高。因此, 在判断血,,的节节节节节节节节节节节节节节节节节节节节节节节定果考有无些影响因素。近年也有人定尿,,以反映,,的分泌情况。尿,,的排泄量节节节节节节节节节节节节节节节节节相当于垂体,,分泌量的,,左右,其度很低,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节需用高度敏感的方法方可出,目前一般采用,,,,法或化学节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节光法。大多数肢端肥大症病人尿,,的排泄增加,但少数可在正常范内。尿,,水平和,,,血,,整合之的相性节节节节节节节节节节节节节节节节节节节差,且定果受功能影响节节节节节节节节节节节节节节节节节节节节大,故其明。，,,血、意尚步有尿,待,一, ,,,?定节节节节节节节节节节节节节节节节节节节节节?,但:很多循,都,可生,?,,, 主要来源于肝节节节节节节节节节节节节节节节节节?,且受,,的。,静脉注射,,后血,,,水平升高,其峰节节节节节节节节节节节节节节节节节节节?半衰出于,注期射后,,,,。,,,,,,,，,,的半衰期不到,:,,,,而且是非脉冲性分泌,故血,,,?,不像血,,那节节节节节节节节节节节节节节节节节节节节节节节波?次,。因此,血,,能次更血好,,, 地反映垂体,,的分泌情况。　研究表明,空腹血,,,?,与疾病活及节节节节节节节节,,,血,,整合有很节节节节节节节节节节节节节节节节节节节节?与肢端肥大症的好的相性,而且血,,,, 床表也节节节节节节节节节节节节节节节节节节节节?密切水平的相。肢端肥大症治后血,,,,降低程度与症状的改善程度是平行的,而且治后血,,,?,水平正常者其生存率也接近正常。此外,在,,受体存在缺陷的,,,:,合征,节节节节节节节节节节?治,予,,,可使身高明增加,但如节节节节节节节节节节节节节节节节节节节节节节节节节量大可引起肢端肥大症的表。可 ,,,?,作,,作用的节节节节节节节节节节节节节节节节节节节节节节节介者可,,的靶腺激素。血,,,?,水平节节节节节节节节节节节节节节节节节节节节定具有重要的意,已成肢端肥大症和 巨人症节节节节节节节节节节节节节节节节节节节节节节节节节断、疾病活度及效察的重要指。前已述及,肢端肥大症病人的,,水平与正常,,水平之有节节节节节节节节节节节节节节节节节重叠,限制了次,,定的用血,,,?定,节节节节节节节节节节节节节节节节节节节节可在一定程度上克服一限制。据道,不基,,水平正常的肢端肥大症病人血节节节节节节节节节节节节节节节节节节节节节节?,,,,已有升高,更重要的是,即使糖耐量程节节节节节节节节节节节节节节节节节节节节中血,,能抑制到正常范,血,,,?,,亦有所升高。可,血节节节节节节节节节节节节节?定,的,敏,感性不高于 次血,,节节节节节节节节节节节节节节节节节节节节节节节节定,而且于糖耐量。此外,在接受生激素受体拮抗治的肢端肥大症病人,节节节节节节节节节节节节节节节节节节节节节?水,只能用血,,,平作效的节节节节节节节节节节节节节节节节节节节节节节节节节节指，此定血,,水平没有意,。血,,,?,不受节节节节节节节节节节节节节节节节节节节节节节餐、运、激及取血的影响,但与年密切相。血节节节节节节节节节节节节节节节节节节节?度在青春期,,,达到高峰,其后随着年,的增节节节节节节节节节节节节节节节节节节节节节逐下降每,大,:年下降,:,,,,,。美步国麻省医院节节节节节节节节节节节节节节节节节节节节节节节节道:,,,,,的正常参考,,,,:,:,,,,，,,,,,,节节节节节节节节节节节节节节节节节节节节节节节节节,,,,,,,,,,,，,,:,,,,:,,,:,,,,，,,,以上节节节节节节节节节节节节节节节节节节:,,,,:,,,,，。血,,,?,,水平受性激素的影响,因此,男女两性血,,,?水平有一定的差异。一般来节节节节节节节节节节,男性血,,,?,水平高于女性。如果接受雌激素治,女性血,,,,,?水平更低。非青春期和妊娠者血,,,?升高提示,,分泌增多。,，,,,:,,等道,未治的活性肢端肥大症病人血节节节节节节节节节节节节节节节节节节节节?水,,,,平正常人的,:节节节节节节节节节节节节节节节节节?定肢端肥大症和巨人症倍。血,,,然,具有重要的意节节节节节节节节节节节节节节,但?目前国内尚未能广泛,展。此外,血,,,定本身也存在一些节节节节节节节节节节节节节节节节节节节节节。研究示,在血,,整合不太高的情况下,血,,,?,与血,,整合之性系节节节节节节节节节节节节节节节节节良好,但当血,,整合节节节节节节节节节节节节节达到,:,,:,,,,，,血?水平,达到,,平台,即不再,随血,,整合的升高而升高。此外,由于大多数节节节节节节节节节节节节节?在血中,,,,同特定的合节节节节节节节节节节节节节节节节节节节节节节,蛋白合在一起，以游离形式存在的,,,?只占,节节节节节节节节节节节节节节节节节节节?的,,,,左右,,故用放射免疫和免疫放,射等方法节节节节节节节节节节节节节节节节节节节节节节出的果都受到影响。,,,,,,,,,等建节节节节节节节节节节先用酸，,,,,,:,抽提,使,,,?同其合蛋白解离,随后用乙醇沉淀大分子蛋白节节节节节节节节节节节节节节节节节节节节合物。用方法可在一定程度上去除,,,?,节节节节节节节节节节节节节节节节节节节节节节节节合蛋白的影响,因此,出的数不理的本 高,,,倍。近年,,，,,等建先节节节节节节节节节节节节节节节节节用酸分离合蛋白,然后加入量的胰节节节节节节节节节节节节节节节节节节节节节节节?素生因，,,,,,子?,,使残留的合蛋 白被,,,,,,?吸附,最后用高度特异的抗,,,?抗体，与,,,?的交叉性极低,节节节节节节节节节节节节节节节节节节节?定的度。,理后品,中，,,,, ,倡节节节节节节节节节节节节节节节节节节节节节节节法的两可以步避免合蛋白的影响,在国外已广泛节节节节节节节节节节节节节节节节节节节节节节节节节节展。之,不同室由于定方法等方面的差其正常范节节节节节节节节节节节节节节节节节节节节节节节节节节可有大的差异,在判定定果注意点。,,,,?也可入节节节节节节节节节节节节节节节节节节节节节节节节节尿液中,且主要体形式。国外有人道,肢端肥大症病人尿,,,?,水平升高,且与正常范节节节节节节节节节节节节无重叠,不其确切的断价节节节节节节节节节节节节节节节节节节节节节节研究。，尚待步一,,血,,,合蛋白定:,,,节节节节节节节节节节节节节节节节节节,,合蛋白,,血中，,,存在的一族能与,,,,,,?和,,,?节节节节节节节节节节节节节节节节节节节节节合的蛋白,,,,,,至少有,,与,,状节节节节节节节节节节节节节节节节节节节节节,和密切,相的是,,,,,,,,,,,。,, ,,,,,和,,水平,,呈节节节节节节节节节节节节节节节节节相,肢端肥大症患者,,,,,,水平降低,治后节节节节节节节节节,水平升高,故血随着,,水平的下降,,,,,,,,,,,,,,节节节节节节节节节节节节节节节节节节节节定肢端肥大症和巨人症的断及效判断都具有一定的价节节节节节节节节节节节节节节节,。和血,,水平,,,,,呈正相,注射,,,可使血,,,,,,,,水平升高。正常人血,,,,,,节节节节节节节节度,,,,,,,,肢端肥大症病人血,,,,,,,,水平升高,治后节节节节节节节节节节节节节节随着,,水平的降低,,,,,,,亦降低。国外节节节节节节节节节节节节节节节节节料示,有些肢端肥大症病人血,,可被葡萄糖抑制且血,,,?,,水平升高不明,但血节节节节节节节,水平明升,,,,,高,因此,节节节节节节节节节节节节节节节节节,定血具有,,重要的,,意,。,,血,,,,,节节节节节节节节节节节节节节节节节节节节节节节节节节节定　血,,,,定肢端肥大症和巨人症的病因有一定的意节节节节节节节节节节节节节节节节节节节节,,高分泌引起的,,多者血,。下丘,,, ,,,可不升高。如果,,多因中节节节节节节节节节节节节节节节节节节节节枢神系以外部位生的异位,,,,所致,血,,,,可升至节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,,,:,,,,，甚至以上，其他型肢端肥大症和巨人症病人外周血,,,,低于,:,,,,，,。由于异位,,,,合征肢节节节节节端肥大症和巨人症的少节节节节节节节节节节节节节节节节节节节节节节节节节节病因，不到,,,,故血,,,,定上用极少。,,其他垂体激素及靶腺功能节节节节节节节节节节节节节节节节节定　,,,的肢端肥大症病人伴有血,,,水平的升高,多由于催乳生激素胞瘤或节节节节节节节节节节节节节,,,混合性,,,瘤所致。有血,,节节节节节节节节节节节节节节节节节节节节节节节节节节,的升高是由于大腺瘤迫垂体柄所致,此血,,,一般呈节节节节节节节节节节节节节节节节节节节节节节节节节节至中度升高。多激素型瘤除分泌,,,外可生其他垂体激素如,,,及,,,,等,从而引起节节节节节节节节节节节节节节节节节节些激素水平的升高,但很少。如,,瘤大,迫正常垂体,可引起一节节节节节节节节节节节节节节节节节节节节节节节节些腺垂体激素的不足,受累垂体激素的节节节节节节节节节节节节节节节节节节节节节序:,,,,,,,,,,,,,,,,。靶腺激素的水平依相的垂体激素水平而节节节节口服糖定,可升高亦可降低。,,耐量节节节节节节节节节节节节节节节节节节节节节节节，:,,,,　肢端肥大症和巨人症糖耐量多减退,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节重者空腹血糖升高,故所有病人在初都做空腹血糖定和:,,,,以判断病人糖代节节节节节节节节节节节节节节节节节节节受程度。在做:,,,可同定血,,,正常人血糖的升高可抑制,,的分泌,本症病人血,,受抑不明节节节节节节节节甚至反常地升高一般采用:,,葡萄糖,前臂静脉留置节节节节节节节节节节节节节节节节管采血,分于,,:，即注射前,:,,,,,:,,:,,:,,:,,,:,,,:,,,采血，也有人只于:,,:,,:,,:,,,:,,,采血,血糖和血,,。正常人于糖节节节节节节节节节节节节节节节节节节节荷后血,,最低在,,,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,,，以下,本症病人血,,不受抑制或部分受抑,血,,最低仍，,,,,,，,甚至反常升高。近年有人用高度敏感的,,节节节节节节节节节定方法正常人的:,,,作了研究,血,,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节几乎都可被抑制到,,,,,，以下,其中,,,的人可抑制到:,,,,,,,，以下,明去所节节节节节节节节节节节节节节节节定的,,抑制限，,,,,,，,偏高,目前向于节节节节节节节节胰素的低将,,抑制限定在,,,,,，。,,血糖　正常人在低血糖,,的分泌节节节节节节节节节节节节节节节节节节节节节节节节节节节著增加,肢端肥大症病人一节节节节节节节节节节节节节节节节节节节节节节节节节节节节反重受。本的做法:静脉注射胰素，量:,,,,:,,,,,体重,,,,:,:,,:,,:,,:,,,:,,,采血血节节糖和血,,。正常人出低血糖后节节节节节节节节节节节节节节节节节节节节节节节节节,:,,:,,,血,,达峰,肢端肥大症病人血,,可不升高甚至降低。有人节节节节节节节节节节节节节节节节节节节节节察了,,例肢端肥大症病人胰素的低血糖的反节节节节节节节节节节节节节节节节节节节节节节节,,例反异常,其中,例血,,下降,,例血,,水平无明化。低血糖的果与血糖有很大系,一节节节节节节节节节节节节节节节节节节节节节节节节节般节节节节节节节节节节节节节节节节节节节节节节节节节节节最低血糖达到空腹血糖的,:,以下,否加大胰素量,直至出明的低血糖节节节节节节节节节节节节节节节节节节节节节节节节止。老年病人特是合并有心血管 病的病人低血糖的节节节节节节节节节节节节节节节节节节节节节节节节节节,耐受性差,慎行低血糖。,,,,,　,,,,的节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节做法如下:病人空腹,静脉注射,,,,,::μ,,分于节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,,,,:,,,,,:,,,,,:,,:和,,:,,,采血,,。节节节节节节节节节,:,的垂体,,瘤病人于注射,,,,后血,,水平升高,峰基的,倍左右。由于相当一部分垂体,,瘤,,,,节节节节节节节节节节节节节节节节节节节节无反,故,,,,以垂体,,瘤和异位,,,,合征,而且有节节节节节节节节节节节节节节节节节节节节节些正常人,,,,也有很好的反节节节节节节节节节节节节节节节节节节节节节节节节节节节节节。故,,,,肢端肥大症和巨人症的断价有限。:,,,,　节节节节节节节节节节节节节节节节节节节节节节节节,,,正常的,,胞没有作用,但节节节节节节节节节节节节节节节节节节节节节节节有,:,的,,胞瘤,,,有反,故,,,肢端 肥大症和巨人症具有重要的节节节节节节节节节节节节节节节节节节断价。由于,,,有反者一般多巴胺激也有很节节节节节节节节节节节节节节节节节节节节节节节节节好的反,故,,,有助于治方法的。节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,,,的做法是:病人空腹,静脉注射,,,,::μ,，也有人使用,::μ,,,分于节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,,,,:,,,,,:,,,,,:,,:和,,:,,,采血，也有人只于:,,:,,:,,:,,,采血,,,。,,瘤病人于节节节节节节节节节节节节节节节节注射,,,后,,,,,血,,水平即升高,高峰节节节节节节节节节节节节节节节出于注射后,:,,,。血,,水平基增加节节节节节节节节节节节节节节节节节节节节节节节节节,:,以上或增加的超,,,,,，节节节节节节节节节节节节节节节节节节节节节节节节节节节节节阳性。,,,阳性的病人其瘤多小,,,,血,,整合多低,病人节节节节节节节节节节节节节节节节节节节节节节节节蝶手的效果一般好。正常人注射,,,后血,,,升高,,,瘤病人，尤其是合并甲状腺的病人,一节节节节节节节节节节节反明减弱甚至消失,其原因可能:,,可刺激生抑素的节节节节节节节节节节节节节节节节节节节节放,从而抑制,,,的分泌,,,及,,,?,可刺激甲状腺的增生,久之可使甲状腺功能出节节节节节自主性向,瘤正常垂体的迫使节节节节节节节节节节节节节节节节节节节节节节节节节,,,胞的功能降低,,,,可与,,瘤胞合,节节节节节节节节节节节节节节节节节节节节节从而限制了它同正常,,,胞的合。有些病人治后血,,和节节节节节节节节节节节节节节节节节节节?降,至正常水平后,,, ,,,节节节节节节节节节节节节节节节节节节节节节节节节节,,,的反仍不能完全恢。,,,有一些不良反,如引起血升高、节节节节节节节节节节节节节节节节节节节节节节节心、腹部不适、尿急等。慢性肝病、功能衰竭、神性节节节节节节节节节节节节节节节节节节节节节节食症、抑郁症,,,亦可促,,的分泌,判断节节节节节节节节节节节节节节节节节节节节节节节节,果,,,　,予注意。,,,,,可刺 激肢端肥大症病人,,和,,,的节节节节节节节节节节节节节节节节节放。,,,,做法:病人空腹,静脉注射,,,,,::μ,,分于:,,节节节节节节节节节节节节节节节节节节节节节,,,:,,:,,:和,,:,,,采血,,和,,节节节节节节节节节节节节节节节节节节节节节节节节节节,。,,,的本症病人,,,,有反,,,峰节节节节节节节节节节节节节节节节节节节节节节节出于注射,,,,后,,或,:,,,,,,,峰节节节节节节节节节节节节节节节节节节节节节节节节节多出于注射,,,,后,,,,,。,,,,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节不可用于肢端肥大症的断,而且治方法的有一定价:,,,,有反节节节节节节节节节节节节节节节节节节节节节节节节节的病人一般生抑素似物有好的反,病人可用生抑素似节节节节节节节节节节节节节节节节节节节节节节节节节节左旋多,巴和物治。亭,　左 旋多巴在中枢神系和外节节节节节节节节节节节节节节节节节节节节节周都可被化多巴胺,在正常人它可刺激,,的节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节放。但是,左旋多巴却抑制肢端肥大症病人,,的分泌。左旋多巴的做法如下:病人空腹,口服左旋多巴,::,,,分于节节节节节节节节节节节节节节节节,,,,:,,:,,:,,:和,,:,,,采血,,。节节节节节节节节节节节节节节节节节节节节节节节节节节若血,,被抑制到基的,:,以下,阳性。节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节::,的肢端肥大症病人左旋多巴阳性。亭的做法:口服亭节节节节节节节节节节节节节节节节节节节节节,或,,,,,　分于:,,:,,,:,,,,采血,,。在正常人,上节节节节节节节节节节节节节节节节节节节节节节节节节节节述量的亭可刺激,,的放,但在肢端肥大症病人抑制,,的分泌。节节节节节节节节节节节节节节节节节节节节节节节节节节节节,:,,,:,的病人亭阳性。精氨酸和生抑素用节节节节节节节节节节节节节节节节节节节节节节节节节节节节少,不予述。【断与断】 ,,节节节节节节节节节节节节节节节节节节节节节断　如病人有典型的床表,断并不困。床表不典型者，如早期病人,可通节节节节节节节节节节节节节节节节节节节节节节节有室和影像学以确立断。疑似病例可先行以下,节节节节节节节节节节节节节节节节节节节节节节节:血,,定，最好定,,,血,,,如有困节节节节节节节节节节节节节节节节节节节节?定可于,,,:内,,定,,,次,,血,,, ,,。如,节节节节节节节节节节节节节节节节节节节节节节节均异常,肯定活性肢端肥大症，或巨人症,,如,节节节节节节节节节节节节节节节节节节节节节节节节均正常,排除肢端肥大症，或巨人症,,如节节节节节节节节节节节节节节节节节节节节节节节节节节节节果在界水平,做,,,或左旋多巴，也可做,,,,,,如节节节节节节节节节节节节节节节节节节节节节节节节节节阳性提示肢端肥大症,如皆性,排除肢端肥大症。垂体影像学断节节节节节节节节节节节节节节节节节节节节节节也极重要,一般,,,,的断价节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节于,,。如影像学有阳性,室有,,高分泌的据,即使床表不节节节节节节节节节节节节节节节节节节节节节节节节断，,,肢端肥,典型,亦可断。, 大症的节节节节节节节节节节节节节节节节节节节节节节节节节节节断:肢端肥大症的断包括两个方面,肢端肥大症 与其他疾病的,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节即确定肢端肥大症是否存在,肢端肥大症病因的。?肢端肥大症与其他疾病的:主要有节节节节节节节节节节节节节节节节节节节节节,。肢端肥大症，,,,:,,,,，:,,,,,,:肢端肥大症与肢端肥大症的表很相似,病人也节节节节节节节节节节节节节节节节节节节节节节有肢端肥大、皮增生厚,节节节节节节节节节节节节节节节节节节节节节节甚至可有肢端肥大症面容。肢端肥大症是由一节节节节节节节节节节节节?特殊的生因的、不同于,,和子，也称,,,,肢端肥大症生因节节节节节节节节节节节节节,子,,,,引起的,故其,,,,,,是正,,常的,病人节节节节节节节节节节节节节节节节节节节节节节节各,,激的反亦正常,借此可与肢端肥大症。此外,肢端肥大症的垂体节节节节节节节节节节节节节节节节节节节节节节节节节节影像学一般正常,亦有助于其同肢端肥大症的。厚皮性骨节节节节节节节节节节节节节节节节节节节节节节节节节节节节节膜病，,,,,,,,,,:,,,,:,,:,,,,:本病亦称,:,,,,,,,,,:，,,,,,:，é节节节节节节节合征,一家族性疾病。本病与肢端肥大症也很相似:病人有肥大性骨病,肢端粗厚,皮粗节节节节节节节节节节节节节节糙,并可有杵状指。本病病人血,,,,,,?,,,,,,,正常,垂体影像学节节节节亦无异常,借此可与肢端肥大症。性巨人症:性巨人症与肢端肥节节节节节节节节节节节节节节节节节节大症的节节节节节节节节节节节节节节节节节节节节节节节参后文。其他疾病如甲状腺功能减退等然有一些表与肢端肥大症相似,但不。节节节节节节节节节节节节节节节节节节节节节节节节节节节节?肢端肥大症的病因:肢端肥大症节节节节节节节节节节节节节节节节节节节节分断析确其病因。由于垂体,,瘤立后一步 肢端肥大症最常的原因,故节节节节节节节节节节节节节节节节节节节节首先考垂体,,瘤。如垂体影像学节节节节节节节节节节节节节节节节节节节节节节节节示有垂体瘤存在,垂体,,瘤的断基本成立。如病人同有血,,节节节节节节节节节节节节节节节节节节节节,或其他激素如,,,的升高,节节节节节节节节节节节节节节节节节节节节节节节节考多激素型,,瘤。如病人同有甲状旁腺瘤和胰素瘤,节节节节节节节节节节节节节节节节节节节节节节节节提示,,,,。若影像学无垂体瘤的据,但提示有下丘瘤及垂体增生,节节节节节节节节节节节节节节节节节节节节节节考正位,,,,生多引起的肢端肥大症,若垂体和下丘节节节节节节节节节节节节节节节节影像学均无瘤的据,且血,,,,节节节节节节节节节节节节节节节节节节节节节节节著升高,提示异位,,,,合征。如肢端肥大 症的节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节断很肯定,影像学上无垂体和下丘瘤的据,且血,,,,不高,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节想到异位,,瘤的可能。，,,巨人症的断:,,多性巨人症节节节节节节节节节节节节节节节节节节节节节节节节节节节与其他可引起高身材的疾病相。?生理性高身材，,,,,,:，:,,,,,，，,,,,,,,,:生理性高身材也称节节节节节节节节节节节节节节节节节节节节节节家族性高身材，,,,,，,,，,,，，,,,,,,,,,其身高界限尚不一。节节节节节节节节节节节节节节节节节节节节节节,,,,,,,,,提出的准:男性身高超节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,,,,,,女性身高超,,,,,。由于身高受族、节节节节节节节节节节节节节节等因素的影响,故确定生理性高身材的身高界限考些因素。生理性高身材并非病,人节节节节节节节节节节节节节节节节节节节节节除身材高大外余皆正常。生理性高身材常有家族史,其父母多身材高大。生理性高身材的垂体影像学节节节节节节节节节节节节正常。生理性高身材者,,,,,,节节节节节节节节节节节节节节节节节节节节节节节节节节节有无异常,目前尚不很清楚。有研究,生理性高身材者,,的分泌正常人高,其基血,,节节节节节节节节节节节节节节节节节节节节节节节略高于正常,,,,,,和葡萄糖的反节节节节节节节节节节节节节节节节节节节节节节亦不正常。也有道称,生理性高身材者血,,,?,水平略高于正常,但也有道二者节节节节节节节节节节节节节节节节节节差异无学意。看来,生理性高身材者血,,、,,,?,水平即使有升高也很节节节节节节节节节节微。与,,高分泌性巨人症是不同的,后者,,,,,,节节节节节节节节节节节节节节节多有著的化。?性巨人症，,,,,,,,，,,,,,,,,,,:性巨人症由节节节节节节节节节节节节节节节节节节节,:,:,最先描述,亦称,:,:,合征。节节节节节节节节节节节节节节节节节节节节节节节节格地,性巨人症一并不确切,因病者只是在幼年和少年期得高大,其成年后节节节节节节节节节节节节节节节节节节节少有身材高大者。此病很少节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,多有家族史。病者在胎儿期即有生加速,故其出生的身、体重即超节节节节节节节节节节节节节节节节节节节节节节节节节节节正常。出生后病孩生正常儿童快,其骨也正常大,故其最身高多在正常节节节节节节节节节节节节节节节节节节节节节节节节节节节范。性巨人症可有肢端肥大症表, 如皮粗节节节节节节节节节节节节节节节节节节节节节节节节节节节节节糙、肢端粗大等,但一般并不重。性巨人症多有部异常,如精神障碍、智力低下及节节节节节节节节节节节节节节节节节节节室。性巨人症的垂体、甲状腺、上腺等内分泌腺功能正常。?,,,,,,合征:罕的性疾病。病节节节节节节节节节节节节节节节人身材瘦节节节节节节节节节节节节节节节节节节节节节节节节节节,手指和脚趾呈蜘蛛,胸廓狭呈胸。病人同有心血管表和节节节节节节节节节节节节节?正常。眼病。血,,和?,,,,,,,,,,,,,,,,,,,,,,合征:病者出生身体节节节节节节节节节节节节节节节节节节节节节重即超正常,且常有低血糖。成年后身材超节节节节节节节节节节节节节节节节节节节节正常,内和舌亦大,但小,且有疝。病人的身材异常与高胰节节节节节节节节节节节节节节节?素血症有。血,,和正常。,,,,?性早熟:性早熟儿童生节节节节节节节节节节节节节节节节节节节节节迅速,其身高超同正常儿童,人以身材高大的感节节节节节节节节节节节节节节节节节节节节节节节。上,此儿童的最身高多正常或略低于正常，因性腺的节节节节节节节节节节节节节节节节节节节节节节早育使骨提前合,。性早熟儿童性育提前,,,和,,,?,正常,借之可与,,多性巨人症。节节节节节节节节节节节节节节节?性腺功能减 退性高身材:性激素有促节节节节节节节节节节节节节节节节节节骨合的作用,故成年前的性腺功能 不足可致骨合节节节节节节节节节节节节节节节节节节节节节节节延,使得最身高超正常。病者体形高瘦,四肢,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节指距一般大于身高,下部量超上部量,性腺育不良,生殖器幼稚,副性征缺如,性激素水平低下,血,,和,,,?,正常。此疾病很多,节节节节节节节重要的有:,,，，,,,,合征:节节节节节节节节节节节节节节节节节节节节节节,,，，,,,,合征是一性促性腺激素缺乏症,节节节节节节节节节节节节节节节节节节节节家族性疾病。此病的致病基因已克隆,位于,染色体的,,,,,,区,其节节节节节节节节节节节节节节节节节物一神元迁移蛋白。基因的缺失或突可致,,,,神节节节节节节节节节节节节节节节节节节节节节节节元迁移障碍,使得,,,,,,分泌不足,从而引起性腺功能不全。本症同有节节节节节节节节节节节节节节嗅神元迁移障碍,故病者有嗅节节节节节节节节节节节节节节节节节节节节节节节节节节节的缺失。一些下丘病如瘤、炎症等可害,,,,神节节节节节节节节节节节节节节节节节节节节节节节节节节节元,使,,,,生减少,,,,,,,分泌不足,从而致性腺功能减退,病者除性腺功能不足外可有下丘功能紊乱的表。节节节节节节节节节节节节节节节节节节节节节节克特合征，节节节节节节节节节节节节节节节节节节节节节,,:,,,精管育,不全症,,,,,,,, ,,,，,,,,,,,,,,,,,:本症亦称,，,,,,,，,,,合征,节节节节节节节性疾病,其病因性节节节节节节节节节节节节节节节节节节节节节节染色体畸。病者染色体核型多,:,,,,。本症病人指距小于身高,与其节节节节节节节节节节节节节节节节节他型的性腺功能不足者不同,同明病人的高身节节节节节节节节节节节节节节节节节节节节节节节节节节节节材不因雄激素不足所致,因雄激素不足者指距一般大于身高。,，,,,,,，,,,合征节节节节节节节节节节节节节节节除身材高大外,有精神异常、男性乳房育节节节节节节节节节节节节节节节节节节节节节节节节节节节节、上部量与下部量之比降低。,,多性巨人症的病因同肢端肥大症。【治】　治的节节节节节节节节节节节节节节节节节节节节节目的是使生化指恢到正常,控制瘤的大节节节节节节节节节节节节节节节节节节节节节节节节节小,解床症状和体征,保持垂体的正常功能改善生活节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节量。肢端肥大症和巨人症的根本原因在垂体,故有的治方法都是节节节节节节节节节节节节节节节节节节节节节垂体的,治的是?水平。如,降低血,,和,,, :,,,节节节节节节节?中血,,水平可抑制水平正常到,,,,,，以下,血,,,,,可已床治节节节节节节节节节节节节节节节节节节节节节节节节愈。少数病人因异位,,,,的分泌而引 起,,分泌增加,治的节节节节节节节节节节节节节节节节节节节手重点治,放在原瘤的根除上。, 手节节节节节节节节节节节节节节节节节节节节节节节切除,,瘤是本症目前的首治方法。有鞍上和，或,鞍旁展节节节节节节节节节节节节节节节节节节节节节节节节节者用手,其他均采用蝶手。手效果与节节节节节节节节节节节节节节节节节节节节节节节节瘤的大小、前,,水平及者的技巧有。局限于鞍内的微腺瘤，直径，,:,,,,手节节节节节节节节节节节节节节节节节节节节节节节节节效果很好,治愈率达,:,,,:,,大腺瘤特是伴鞍上和，或,鞍旁展节节节节节节节节节节节节节节节节节节节节节节者手效果差,治愈率不到,:,。手可有效地减节节节节节节节节节节节节节节节节节节节节节节节节瘤的占位效,改善迫症状,并可降低血,,水平。据国外文献节节节节节节节节节节节节节节节节节节节节节道,,:,的病人后基,,水平可降至,,,,,，以下,床症状亦有明改节节节节节节节节节节节节节节节节节节节节节节善。有些床表如身材、面容的异常及肢端的肥大是不能逆节节节节节节节节节节节节节节节节节节节节的,但可停止展。是手治的一大障碍,后节节节节节节节节节节节节节节节节节节节节节节节节节节节,,,年率可达,:,。者可采用内科物治或放射治。肢端肥大症病人常有舌肥大,上节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节呼吸道亦常狭窄,在麻醉予注意,麻醉插管和拔管节节节节节节节节节节节节节节节节节节节均小心,以防出气道阻塞和窒息。,,放射治　,节节节节节节节节节节节节节,:,年,法国学者,é,，è,,和,,,,,,,,第一次将放射治节用于肢端肥大症。此后不节节节节节节节节节节节节节节节节节节节断改,放射治一度成肢端肥大症主要的治节节节节节节节节节节节节节节节节节节节节节方法。,:世,:年代以后,随着蝶垂体手节节节节节节节节节节节节节节节节节节节节节节节节地不断改,手治效果不断提高,放射治的重要性有所下降。目前放射治主要用于节节节节节节节节节节节节节节节节节节存在手禁忌的病人或手切除不节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节底及后者。放射治的方法有多,主要有超高放射治、α粒子放射治、节节节节节节节节节节节节节节节节节节节节节节节节节节,:,，,置入治及立体定向放射治等。目前多主节节节节节节节节节节节节节节节节节节节节节节节节节节采用直加速器或伽刀等立体定向治方法,其效果于普通放节节节节节节节节节节节节节节节节节节节节节节节节节节,而放射小于普通放。放射治起效慢,血,,的下降也节节节节节节节节节节节节节节节节节节节节节节节慢。一般来,放射治在控制血,,水平方面具有节节节节节节节节节节节节节节节节?好水平不理的效果,但想控。因此,制血,,放射,治,后要节节节节节节节节节节节节节节节节节节节节节节节节节,予生抑素似物等抗分泌物以控制血,,,?水平。放射治的节节节节节节节节节节节节节节节节节节节节节节副作用主要垂体功能减退,生率高达,:,。此外,放射治可节节节节节节节节节节节节节节节节节节节节节害交叉及下丘腹。近年有人采用生抑素受体节节节节节节节节节节节节节节节节节,,,:,,,,,,,靶向放射治，,:, ,,,,,:,,,,,,,,,,,,,,:,,,,,,,,,取得节节节节节节节节好的效果。方法是将同位素节节节节节节节节节节节节节节节节节节节,到生抑素似,物，主要是,,,,,,,,,,奥曲节节节节节节节节节节节节节节节节节,:和,,:,,,,,,,奥曲,上,再将节节节节节节节节节节节节节节节节节节节节节节节节节节节物予病人,物在病人体内与瘤胞膜上的生抑 素受体合,节节节节节节节节节节节节节节节节节节节节节节节节通所受体介的内化，,,,,,，,,,,,:,,作用节节节节节节节节节节节节节节节节节节节节节节节物入到瘤胞内,从而瘤胞。生抑素 受体靶向放射治节节节节节节节节节节节节节节节节节节节节节节节节目前　尚于段,但其独特的治思路已示其广节节节节节节节节节节节节节节节节节节节节节节节节内的用前科物,景治，,,生抑素似。,物:生抑素节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节通作用于其受体，,:,,,:,,,,,,,,,,,,:,,,,,,,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节作用。,,,,有,型，,,,,,,,,,分称,,,,,,,,,,,,,,,,,,,,,,,和,,,,,。除,,,,,外,其余,节节节节节节节节节节节节,,,,在垂体,,胞都有表达,其中以,,,,,和,,,,,最节节节节节节节节节节节节节节节节节节节节重要。,,,,在垂体,,胞瘤亦有高水平表达,是生抑素似节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节物治肢端肥大症的基。据道,,:,的垂体,,瘤胞表达,,,,,,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,,,的垂体,,瘤胞表达,,,,,。静脉注射生抑素可使本症患者血,,迅速下降,但作用很快消失,原因是生抑素的节节节节节节节节节节节节节节节节节节半衰期太短，，,,,,,。因此,生抑素本身节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节无治价。目前床使用的生抑素似物奥曲，:,,,,:,,,,,商品名“”节节节节节节节节节节节节节节节节节善得定,,于,,,,年首次用于肢端肥大症的治,节节节节节节节节节节节节节节节节节节节节节节节节目前已取得良好的效果。奥曲八,通激活,,,,,和,,,,,而抑制,,分泌的作用。节节节节节节节节节节节节节节节节节奥曲的半衰期,,:,,,。皮下节节节节节节节节节节节节节节注射,:μ,奥曲节节节节节节节节节节节节节节,血度的峰出于注射后,,,,:,,,,可达,,,,,,,,,,,，。奥曲节节节节抑制,,分泌的作用节节节节节节节节节节节节节节节节节节,天然:,生抑素,:强倍,最大抑制作用 出于皮下节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节注射后,,,,。皮下注射奥曲后,作用可持,,,此后血,,度节节节节节节节节节节节节节节节节节节节节节节节节逐回升。肢端肥大症病人奥曲也有很好的反节节节节节节节节节节节节节节节节节节节节节节节,皮下注射奥曲,,后可使,,度降低到注射前的,:,,,:,,作用可持,节节节节节节节节节节节节节节节节节,小,,,。皮下注目射前常用的,::每方法μ,,部分病人采用,每小节节节节节节节皮下注射,:μ,的节节节节节节节节节节节节节节节方法亦取得良好的效果,而有些病人节节节节节节节节节节节需大量，,,::μ,,,,始能得节节节节节节节节节节节节意的效果。一些大本、多中心的研究果示,节节节节节节节节节节节节节节节节节节节节奥曲可使,,,,,,,的肢端肥大症病人血整合,,水平降至正常,使,:,,,,,的病人血,,,?,水平达到正常。奥曲节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,大腺瘤的效果不及微腺瘤:于大腺瘤,半数病人血,,,?水平达到正常,于微腺瘤,,节节节节节节节节节?水平,,的病人血达到正常。,,,,一般来节节节节节节节节节节节节节节节?,病人治前,,水平水平恢越高,奥曲,治后血,,,正常的可能性越小。奥曲节节节节节节节节节节节节节节节节节节节能使大多数病人的床症状改善,如痛减节节节节节节节节节节节节节节节节节节节节节节节节节节节节、出汗减少。痛减与瘤小有,不,有些病人在注射奥曲节节节节节节节节节节节节节节节节节节节节节节节节节数分之后痛即有减,明有其他机制参与。,:,的病人瘤体节节节节节节节节节节节节节节节节节节节节节小,不小的幅度一般不是太大，多在,:,,,:,,,节节节节节节节节节节节节节节节节节节节节节节节,:,的病人停后瘤体又再度增,但一般不会超节节节节节节节节节节节节节节节节节节节节节节?原来度的的体。瘤的降,小与血,,和,,,低平行。能改节节节节节节节节节节节节节节节节节节节节节节善气道狭窄和睡眠性窒息症状。,,,左右的病人节节节节节节节节节节节节节节节节节节节节节节奥曲反很差甚至没有反,称奥曲抵抗,节节节节节节节节节节节节节节节节节节节节节节节与瘤胞表面生抑素受体，主要是,,,,,,的密度和和节节节节节节节节节节节节节节节节节节节节节节节节力有,受体数目少且和力低效差,受体数目多且和节节节节节节节节节节节节节节节节节节节节节节节节力高效好。垂体手前使用奥曲使瘤小,可提高手节节节节节节节节节节节节节节节节节节节节节节节治的成功率并降低后率。奥曲亦可抑制胰节节节节节节节节节节节节节节节节节节节节节节节素的分泌,此作用其抑制,,作用的,,,,,可持节节节节节节节节节节节节节节节节节节节节节节节节,,,,。部分病人在治程中出糖代紊乱，主要节节节节节节节节节节节节节节节节节节节节节节节节节节餐后高血糖,,可能奥曲的副作用所致,但如治前即有糖尿病,节节节节节节节节节节节节节节节节节节节节节节奥曲可通抑制,,的分泌而改善糖尿病症状。奥曲节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节可抑制餐后胆囊的收,从而使胆石症病率增加，,,,的用者出胆石症,。胆石症的生与节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节奥曲的量无,且一般不生症状。如在餐后,,,,用可减少副作用。在奥曲节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节治程中可出心、腹、腹痛等,些胃道症状与量平行。持使用一段节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节后,些副反常得微甚至消失,是由于奥曲其受体有降作用之故。,,,的病人出节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节心,但一般并不重。近年有些制公司将奥曲包裹于可生物降解的多聚体微球，,,:,,,,,,,,，,,,,,:,,,,,,,中,形成效节节节奥曲节节节节节节节节节节节节节节节节节节节节节节,,,,,,,,，,,,,,:,,,,:,，:,,,,:,,,,，:,,,,,,,,,,,。，,:节节节节“节节节节节善,,,,,,,公司出品的效，,,,奥曲商品名,:,,,,,,,,,,,,已用于床,得”节节节节节节节节节节节节节节节良好的效果。注射效奥曲节节节节节节节节节节节节节节节节节节节节节节节节节节后,奥曲从微球慢放出来,作用可持,,,周。因此,效节节节节节节节节节节节节节节节节节节节月肌奥曲内注每射,次即可。一般来,注射,,,次后,血奥曲节节节节节节节节节节节节节节节节节节节节节节节度就可达到水平。效奥曲的起始量一 般,节节节节节节节节节节节节节节节节?水平:,,,以后整量，多,:根据血,,,,,:,,,,。除奥曲节节节节节节节节节节节节节节节节节节节节节节节外,有若干生抑素似物,如，，,,,,:,,,,,、威节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节，,,,,,:,,,,,及,,,,,,,:,,,,,,,:,,,:,,,:等，表,,,。、,节节节节节节节节节节节节节节节节节威和奥曲很相似,都通节节节节节节节节节节节节节节节节节节节节,,,,,和,,,,,作用,其效和副作用也相当。,,,,,,,:和,,,,,,:,性节节节节节节节节节节节节节节节节节节节节,,,,激,前者只激活,,,,,,后者只激活,,,,,。,:,,,:节节节节节节节节节节节节节节广,,,,激,能激活除,,,,,以外的所有,,,,,效果可能于性节节节节节节节节节节节节节,,,,激。,,,,,,,:,,,,,,,:,和,:,,,:都节节节节节节节节节节节于段,其效果有待察节节节节节节节节节节节节节节节节节节节节节节节节节节节节节。　　亦有效制，也是通将包裹于可生物降解的微球中而制得,,称，，,,节节节节节节节节节节节节节节节节,,:,,,,,,,,。节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节注射后可持,周左右,因此,推荐的注射隔,:,,,,。节节节节节节节节节节节节节节节节节节节节节节节节节节也已用于床,其效果与效奥曲相当。近年有人提出生抑素受体节节节节节节节节节节节节节节节节节,:,,,,,,,靶向化，,:,,, ,,,,,:,,,,,,,,,,,,,,:,,,,,,,,,治节节节节节节节方法是将化节节节节节节节节节节节节节节节节节节节节节节节节物，如多柔比星,耦到生抑素似物分子上,再节节节节节节节节节节节节节节节节节节节节节节节节节病人注射此耦物,耦物在病人体内与瘤胞膜上的生抑素受体合,节节节节节节节节节节节节节节节节节节节节节节节节节节通受体介的内化作用入到瘤胞内,从而瘤胞。生抑素受体节节节节节节节节节节节节节节节节节节节节节节节节节节靶向化目前于研究段,其确切节节节节节节节节节节节节节节节节节节节节节节节节节效尚待明。，,,多巴胺激:多巴胺激刺激正常人,,的分泌,但可抑制,,瘤的分泌。不,其效果不及生抑素似节节节节节节节节节节节节节节节物。多巴胺激有节节节节节节节节节节节节节节节节节节节节节节节亭、麦角乙胺，，,,,,,,,,、培高利特，,,,,:，,,,,、奎高利特，,,,,,,:，,,,,及卡麦角林，,,,,,,:，,,,,等。目前最常用的节节节节节节节节节节节节节节节亭,于,,:,年首次用于,,瘤的治中。节节节节节节节节节节节节节节节节节节节节节节节节节节节::,,,:,的病人亭有反,病人的床症状可得改善,血,,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节著降低,但其基降至,,,,,，以下的不多。国外料示,节节节节节节节节节节节节节节节节节亭可使?,水平:,的病人血,,降至,,,,,，以下,,:,的病人血,,,,正常,节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节,:,的病人瘤有不同程度的小。亭治,,瘤的量,,,瘤的要高,一般需,:,,:,,,,方可奏效,故不良反节节节节节节节节节节节节节节节节节节节常。据道,奎高利特和卡麦角林的效于节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节亭。，,,生抑素似物和多巴胺激的合治:生抑素似物和多巴胺激节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节都有治肢端肥大症的作用,那二者合用是否能得更好的效果呢,回答是肯定的。不合治的效果于治,而且有节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节节些治抵抗的病人在予合治后可收到一定的效果。近年有人将生抑素似节节节“”节节节节节元件物激其和多,,,,,的巴胺激激活,,受体的“”节节节节节节节节节节节节节节节节节节元件装到一个分子上,出一全新的生抑素受体似物,,,,,,,,:。,,,,,,,,:属于生抑素节节节节节节节节节节节节节节节节节,多巴胺能嵌合配体，,:,,,:,,,,,,,,:,,,,,,,,,,,,,,,,,,，,,,,,,,,它既可激活,,,,,,又能激活多巴胺,,受体。,,,,,,,,:的节节节节节节节世了人用一节节节节节节节节节节节节节节节节节节节节节节节节节节物达到合治效果的梦想。随着制科学的展,相信将来可以出作用节节节节节节节节节节节节节节节节节节节大的嵌合更配强体。，,,生激素受体 拮抗:近节节节节节节节节节节节节节节节节节节节节节节节节节节十多年来,人在生激素作用机制的研究方面取得很大的节节节节节节节节节节节节节节节节节节节节节节节节节展,生激素受体拮抗的成功就是极好的佐。生激素分节节节节节节节节节节节节节节节节节节节节节节节节节节节节节子含有两个受体合位点,激素分子通两个合位点与受体合并受体形成二聚体，节节节节节节节节节节节节节节节节节节节节节,,,,,,从而,, 启节节节节节节节节节节节节节节节节节节节节节节节节节节节受体后信号,最后特定的生物学效。受体二聚体的形成受体的节节节节节节节节节节节节节节节节节节节节节节节节节信号所必需,因此,只有,个合位点都完好的激素分子才能激活受体。有人利用分子生物学手段研制出一,,,似节节节节节节节节节物,称节节节节节节节节节节节节节节节节节节,,:,,。,,:,,的位点,与受体的和力升高而位点,与受体的和力下降,因此,它不能有效地受体形成二聚体,节节节节节节节节节节节节节节节节节节节节节节节从而成受体的拮抗。,,:,,在体内的半衰期很短,没有用节节节节节节节节节节节节节节节价。有人将其上聚乙二醇，,:，,,,,,，,,,,，,,:，,,,,,,即成,,:,,,,,,或称,派索节节节节节节节节节节节节节节节节节节节节节节节节，,,,,,,:,,,,,。派索的半衰期节节节节节节节节节节节节节节节节节节节节节节节节节节节节,,:,,延,免疫原性降低。不,派索与生激素受体的和节节节节节节节节节节节节节节节节节节节节节节节节节节节节力也有所下降,因此,必要高的度才能阻断生激素受体。有人节节节节节节节节节节节节节节节节节节节节节节节节行了一随机、双盲、安慰照的床研究,以估派索节节节节节节节节节节节节节节节节节节节节节节节节的效。共有,,,例肢端肥大症病人入研 究,病人随机分节节节节节节节节节节节节节节节节节节节节节四:,:,,,,派索，皮下注射,,,,,,,,派索节节节节节节节节节节节节节节节节节节节节节节节节,,:,,,,派索和安慰,共 察,,个周。果示,,:,,节节节节节节节节节节节节节节节节节节节节节节,,派索有,,,的病人血,,,?,水平达到正常,,,,,,,派索节节节节节节节节节节节节有,,,的病人血,,,?,水平达到正常,,:,,,,派索节节节节节节节节节节节节节有,,,的病人血,,,?,,水平达到正常,而安慰节节节节节节节节?只水平有,:,的病人血达到正,,,常。与基相节节节节节节节节节节节节节节节节?水平平均比,,:,,降,,派索,血,,,低,:,。随着血,,,,　?水平的下降,病人的床症状也明改节节节节节节节节节节节节节善。研究节节节节节节节节节节节节节节节节节节节节节节节节明,派索肢端肥大症有良好的效果,而且效与量有。节节节节节节节节节节节节节节节节节节节节节节节节节节节节派索的期治效果也相当令人意。有人,派索节节节节节节节节节节节节节节节节节节节节节节节节治,,个月，平均量,,,,,,,可使,:,的病人血,,,?,水平达到正常。同,病人的节节节节节节节节节节节节节空腹血糖和空腹血胰节节节节节节节节节节节节节节节节节节节节节节节节节素水平也有所下降,明派索期治也改善病人的代节节节节节节节节节节节节节节节节节节节节节节。派索有一个缺点,那就是不能使瘤体小，极少数病人可能在治节节节节节节节节节节节节节节节节节节节节节节程中出瘤体增大的象,予手或放射治,。一节节节节节节节节节节节节节节节节节节节节节节节节节缺点使其以作一治。不,有些手后或放节节节节节节节节节节节节节节节节节节节节节节节后的病人生化指仍不正常,就特适合使用派索节节节节节节节节节节节节节节节节节节节节节节节节节节。期使用派索有一个,那就是抗体的生，因节节节节节节节节节节节节节节节节节节节节节节节节节派索本上属于蛋白,。研究示,,:,的接受派索节节节节节节节节节节节节节节节节节节节节节节节节节节治的病人可生派索的抗体,不抗体的滴度低,不节节节节节节节节节节节节节节节节节节节节节节节节影响派索的效果。就有的料而言,派节节节节节节节节节节节节节节节节节节节节节节节节节索治程中没有减敏，,,,,,,,,，,,,,,节节节节节节节节节节节节节节节节节节节节节节节节象。注意的是,派索通阻断,,受体的信号节节节节节节节节节节节节节节节节节节节节节节节节节而作用,因此,它不能使血,,降低。上,病人在节节节节节节节节节节节节节节节节节节节节节节始的两周里血,,水平不降反升,不随后就不再升高。因此,在治节节节节节节节节节节节节节节节节节节节节节程中不能以血,,水平作指,一点与其他治节节节节节节节节节节节节节节节节节节节节节节方法不同。派索的耐受性相当好。最常的不良反节节节节节节节节节节节节节节节节节节节节节节是感染,主要是不重的上呼吸道感染。,:,的病人出节节节节节节节节节节节节节节节节节节节节节节节注射部位度,可自行解,一般不需要治。极少数病人可能出度节节节节节节节节节节节节节节节节节节节肝功能异常，主要是,,,和,:,节节节节节节节节节节节节节节节节节节节节节度升高,,其与派索之的系尚不清楚。一般来,如果出节节节节节节节节节节节节节节节节节节节节节节节节肝功能异常,最好停止使用派索。，,,并症的治:有糖节节节节节节节节节节节节节节节节节节节节节节节节尿病者控制食,并予降糖物。如糖尿病由,,分泌多所致,在,,高分泌状正之前,用节节节节节节节节节节节节节节节节节节节节口服降糖很得理节节节节节节节节节节节节节节节节节节节节节节节想的控制,多需使用胰素,在血,,水平降低后,糖尿病常自行节节节节节节节节节节节节节节节节解。如病人合并有,型糖尿病,在血,,水平降低前,糖尿病亦节节节节节节节节节节节节节节节控制,在血,,水平降低后,糖尿病可有一定程度的解但节节节节节节节节节节节节节节节节节节节仍需使用降糖物,此的治同普通的,型糖尿病。少数病人有甲状腺功能亢节节节节节节节节节节节节症,如病人合并有,,,,,,甲亢,可根据情况节节节节节节节节节节节节节节节节节节用抗甲状腺物、同位素碘或手治,如甲亢由垂体分泌,,,多，多激素型,,瘤,所致,以治节节节节节节节节节节节节节节节节节节,,瘤主。有节节节节节节节节节节节节节节节节节节节节节节心力衰竭、高血者予相的治。