GIPOFIZ ADENOMASI BO'LGAN BEMORLARDA SANDOSTATIN LAR BILAN UZOQ MUDDATLI DAVOLASH SAMARADORLIGI: GORMONAL, KLINIK VA PROGNOZ OMILLARI
Ключевые слова:
akromegaliyaАннотация
Dolzarbligi: Akromegaliya — gipofiz adenomasi tomonidan o'sish gormonining (OG) avtonom gipersekresiyasi va insulinsimon o'sish omili-1 (IOO-1) ning ikkilamchi ko'tarilishi bilan tavsiflanadigan surunkali endokrinopatiya. Ushbu kasallik aholining har bir millioniga 40–70 holatda uchraydi va tartibga solinmagan sharoitda yurak-qon tomir asoratlaridan o'lim xavfini 2–4 barobar oshiradi. Somatostatin analoglari (SA), xususan Sandostatin LAR (uzoq ta'sirli oktreotid), tibbiy davolashning farmakologik asosi hisoblanadi; biroq klinik javobning sezilarli o'zgaruvchanligi individual prognoz vositalariga bo'lgan ehtiyojni dolzarb qiladi. Maqsad: Gipofiz adenomasi bo'lgan bemorlarda Sandostatin LAR terapiyasi samaradorligini baholash va remissiyaga erishishning mustaqil klinik hamda gormonal prediktorlarini aniqlash. Material va usullar: Prospektiv kuzatuv kohort tadqiqotiga akromegaliya tashxisi tasdiqlangan 38 bemor kiritildi (o'rtacha yosh 45,5±13,4 yil; 65,8% ayollar). Ma'lumotlar uch nazorat nuqtasida: davolashgacha, 0–6 oy va 6–12 oy davomida to'plandi. Qo'llangan statistik usullar: Pearson chi-kvadrat mezoni, Kruskal–Wallis testi, DSCF juftlik taqqoslashlari, Pearson korrelyasiyasi, ikkilik logistik regressiya, ROC-tahlil, Koks regressiyasi va Kaplan–Meier hayotiylik tahlili. Natijalar: Davolash fonida OG darajasi 50,2 ng/ml dan 4,56 ng/ml gacha (90,9% kamayish), IOO-1 esa 631 ng/ml dan 63,1 ng/ml gacha (90,0% kamayish) tushdi (p<0,001, barcha taqqoslashlar uchun). Makroadenomalar ulushi 57,9% dan 18,4% gacha kamaydi. Biokimyoviy remissiya 55,3% bemorlarda erishildi. Logistik regressiya bo'yicha remissiyaning asosiy mustaqil prediktorlari: adenoma o'lchami (OR=0,037; 95% DI 0,008–0,180; p<0,001), boshlang'ich OG (OR=0,955; p=0,023) va IOO-1 (OR=1,004; p=0,018). Prognoz modeli AUC=0,924 ko'rsatkichiga ega. Kaplan–Meier va Koks regressiyasi bo'yicha adenoma o'lchami remissiyaga erishish tezligining yagona mustaqil determinanti hisoblanadi (HR=0,136; p=0,004). Xulosa: Sandostatin LAR bilan uzoq muddatli davolash kasallikning kuchli biokimyoviy nazoratini va bemorlarning yarmiidan ko'pida remissiyani ta'minlaydi. Gipofiz adenomasi o'lchami davolash samaradorligining eng muhim prediktori bo'lib, remissiyaga erishish ehtimoli va tezligini belgilaydi.
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