Wallymahmed M E, Foy P, MacFarlane I A
Neuroendocrine Clinic, Walton Hospital, Liverpool, UK.
Clin Endocrinol (Oxf). 1999 Sep;51(3):333-8. doi: 10.1046/j.1365-2265.1999.00802.x.
Adults with GH deficiency (GHD) frequently report a poor quality of life (QOL). Whether this poor QOL is specifically due to hormone deficiency or a non specific effect of a chronic condition is not known. We therefore assessed QOL in adults with hypopituitarism and GHD and compared scores with a group of patients with diabetes mellitus, another life-long condition with potentially serious complications and a group of healthy controls.
We studied 57 patients with hypopituitarism and GHD (peak stimulated GH response < 9 mU/l) (23 male, mean age 36.4 years, mean stimulated GH response 2.3 mU/l), secondary to a variety of hypothalamic-pituitary disorders. Fifty had been treated surgically (39 cranial surgery, 11 transsphenoidal) and 37 had received external cranial irradiation involving the hypothalamic region. Fifty-seven age and sex matched patients with diabetes mellitus (31 insulin treated, 18 on oral hypoglycaemic agents, 8 on diet alone) and 57 matched healthy controls were also studied.
We assessed and compared health related QOL in the 3 groups using 4 self rating questionnaires: Hospital Anxiety and Depression Scale, Self Esteem Scale, Mental Fatigue Questionnaire and Life Fulfilment Scale. In addition the GHD and diabetic groups also completed the Disease Impact Scale.
The GHD group reported significantly more depression (P < 0.05) and mental fatigue (P < 0.05) and significantly less self esteem (P < 0.05) and life fulfilment (P < 0. 05) than either the group with diabetes or the controls. Patients with GHD reported significantly higher anxiety scores (P < 0.05) than the controls. Within the GHD group there were no differences in QOL scores between patients with pituitary tumours (n = 24), craniopharyngiomas/hypothalamic tumours (n = 18) or other brain tumours. In addition there were no significant differences according to surgical treatment modality or radiotherapy. However subgroup analysis revealed that the patients who had undergone transsphenoidal surgery (n = 11) differed significantly from the control group in life fulfillment and depression (P < 0.01) only and did not differ from the DM group in any of the questionnaires used. There were no significant differences between the group with diabetes and the control group in any of the measures except depression (P < 0.05).
This study revealed a significant impairment of QOL in adults with GHD, particularly those who had undergone cranial surgery, when compared to matched patients with diabetes and healthy controls.
生长激素缺乏症（GHD）成人患者常报告生活质量（QOL）较差。目前尚不清楚这种较差的生活质量是具体由于激素缺乏还是慢性病的非特异性影响所致。因此，我们评估了垂体功能减退症和生长激素缺乏症成人患者的生活质量，并将其得分与一组糖尿病患者（另一种有潜在严重并发症的终身疾病）以及一组健康对照者进行比较。
我们研究了57例垂体功能减退症和生长激素缺乏症患者（刺激后生长激素峰值反应<9 mU/l）（23例男性，平均年龄36.4岁，平均刺激后生长激素反应2.3 mU/l），病因是各种下丘脑 - 垂体疾病。50例接受了手术治疗（39例开颅手术，11例经蝶窦手术），37例接受了涉及下丘脑区域的颅外照射。还研究了57例年龄和性别匹配的糖尿病患者（31例接受胰岛素治疗，18例口服降糖药治疗，8例仅接受饮食治疗）以及57例匹配的健康对照者。
我们使用4份自评问卷对3组患者的健康相关生活质量进行了评估和比较：医院焦虑和抑郁量表、自尊量表、精神疲劳问卷和生活满意度量表。此外，生长激素缺乏症组和糖尿病组还完成了疾病影响量表。
与糖尿病组或对照组相比，生长激素缺乏症组报告的抑郁（P < 0.05）和精神疲劳（P < 0.05）明显更多，自尊（P < 0.05）和生活满意度（P < 0.05）明显更低。生长激素缺乏症患者报告的焦虑得分（P < 0.05）明显高于对照组。在生长激素缺乏症组中，垂体肿瘤患者（n = 24）、颅咽管瘤/下丘脑肿瘤患者（n = 18）或其他脑肿瘤患者的生活质量得分没有差异。此外，根据手术治疗方式或放疗也没有显著差异。然而，亚组分析显示，接受经蝶窦手术的患者（n = 11）仅在生活满意度和抑郁方面与对照组有显著差异（P < 0.01），在使用的任何问卷中与糖尿病组没有差异。糖尿病组和对照组在除抑郁外的任何测量指标上均无显著差异（P < 0.05）。
本研究表明，与匹配的糖尿病患者和健康对照者相比，生长激素缺乏症成人患者，尤其是接受开颅手术的患者，生活质量有显著损害。
