Pasieka Janice L, Parsons Louise L, Demeure Michael J, Wilson Stuart, Malycha Peter, Jones Jean, Krzywda Beth
Department of Surgery, Division of General Surgery, University of Calgary, Foothills Medical Center, 1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9.
World J Surg. 2002 Aug;26(8):942-9. doi: 10.1007/s00268-002-6623-y. Epub 2002 May 21.
This study assessed the impact of parathyroidectomy on the preoperative symptoms of patients with primary hyperparathyroidism (1 degrees HPT) using a surgical outcome tool designed specifically for HPT. The multicenter nature of this study allowed us to validate further this disease-specific outcome tool. 1 degrees HPT patients from Canada, the United States, and Australia filled out the questionnaire preoperatively and postoperatively on day 7 and at 3 and 12 months. The symptoms recorded by the patients were expressed as parathyroidectomy assessment of symptoms (PAS) scores: the higher the score, the more symptomatic is the patient. Quality of Life (QOL) and self-rated health uni-scales were included. Altogether, 203 patients with 1 degrees HPT were enrolled; 27 from center A, 54 from center B, and 122 from center C; 58 nontoxic thyroid patients were enrolled for comparison. The comparison group had no significant change in their PAS scores throughout the study (scores 184, 215, 156, 186). All three centers demonstrated a significant reduction in symptoms following surgery. The median preoperative PAS score from center B patients was 282. Following surgery, PAS scores decreased significantly: 136, 58, 0 (p <0.05). Center C patients had a median preoperative PAS score of 344, decreasing postoperatively to 228 (p <0.05) and continuing to decrease to 190, then 180. Center A also demonstrated a significant reduction in symptoms at 3 months, from 510 preoperatively to 209 (p <0.001). Both QOL and self-rated health improved in the HPT patients, whereas no change was found in the comparison group following surgery. PAS scores are a reliable, disease-specific measure of symptoms seen with HPT. Parathyroidectomy significantly reduces these preoperative symptoms, and this change translated into an improved health-related QOL for the patients.
本研究使用专门为原发性甲状旁腺功能亢进症（1°HPT）设计的手术结果工具，评估了甲状旁腺切除术对1°HPT患者术前症状的影响。本研究的多中心性质使我们能够进一步验证这种针对特定疾病的结果工具。来自加拿大、美国和澳大利亚的1°HPT患者在术前、术后第7天以及3个月和12个月时填写问卷。患者记录的症状以甲状旁腺切除术症状评估（PAS）评分表示：分数越高，患者症状越明显。纳入了生活质量（QOL）和自我健康评分单维度量表。总共招募了203例1°HPT患者；A中心27例，B中心54例，C中心122例；招募了58例非毒性甲状腺患者作为对照。在整个研究过程中，对照组的PAS评分没有显著变化（分数分别为184、215、156、186）。所有三个中心均显示术后症状显著减轻。B中心患者术前PAS评分中位数为282。术后，PAS评分显著下降：分别为136、58、0（p<0.05）。C中心患者术前PAS评分中位数为344，术后降至228（p<0.05），并继续降至190，然后是180。A中心在3个月时也显示症状显著减轻，从术前的510降至209（p<0.001）。HPT患者的QOL和自我健康评分均有所改善，而对照组术后未发现变化。PAS评分是一种可靠的、针对特定疾病的1°HPT症状测量方法。甲状旁腺切除术显著减轻了这些术前症状，这种变化转化为患者健康相关QOL的改善。
