McMillan C V, Bradley C, Gibney J, Healy M L, Russell-Jones D L, Sönksen P H
Royal Holloway, University of London, Egham, Surrey, UK.
Clin Endocrinol (Oxf). 2003 Oct;59(4):467-75. doi: 10.1046/j.1365-2265.2003.01870.x.
Growth hormone (GH) is known to be required for physical well-being. Although it is also widely believed to be important for quality of life (QoL) and psychological health, there is less supportive evidence. The objective of this study was to investigate the psychological effects of discontinuation of GH replacement from adults with severe GH deficiency (GHD).
A double-blind, placebo-controlled trial in which GH replacement therapy was discontinued for 3 months from 12 of 21 GH-deficient adults, where nine continued with GH replacement.
GH-treated adults (10 men, 11 women), all with severe GHD (peak GH < 7.7 mU/l on provocative testing), mean age 44.9 years (range 25-68 years).
Semi-structured interviews were given at baseline and end-point plus questionnaires that included a new hormone-deficiency specific, individualized, QoL questionnaire (HDQoL), the General Well-being Index (GWBI), the Well-being Questionnaire (W-BQ12), the Short-Form 36 health status questionnaire (SF-36), the Nottingham Health Profile (NHP) and the General Health Questionnaire (GHQ).
Three months after baseline the serum total IGF-I of placebo-treated patients fell from normal, age-related levels (mean 26.6 +/- 13.2 nmol/l) to levels indicative of severe GHD (11.6 +/- 6.6 nmol/l) (P<0.001). Psychological symptoms of GH withdrawal, reported in interviews at end-point by placebo-treated patients, included decreased energy, and increased tiredness, pain, irritability and depression. Patients who believed they knew which treatment they had received correctly identified the treatment (GH or placebo) at end-point (chi2=11.25, P<0.01). Significant between-treatment-group differences in change scores were found for SF-36 General Health (P<0.01), W-BQ12 Energy (P<0.01) and HDQoL do physically (P<0.05), indicating reduced general health, reduced energy and greater perceived impact of hormone deficiency on physical capabilities in the placebo-treated group at end-point relative to GH-treated patients.
Withdrawal of GH treatment from adults with severe GH deficiency has detrimental psychological effects.
已知生长激素（GH）对身体健康至关重要。尽管人们普遍认为它对生活质量（QoL）和心理健康也很重要，但支持证据较少。本研究的目的是调查重度生长激素缺乏（GHD）成人停用GH替代治疗后的心理影响。
一项双盲、安慰剂对照试验，21名GHD成人中有12名停用GH替代治疗3个月，另外9名继续接受GH替代治疗。
接受GH治疗的成人（10名男性，11名女性），均患有重度GHD（激发试验时峰值GH<7.7 mU/l），平均年龄44.9岁（范围25 - 68岁）。
在基线和终点进行半结构化访谈，并发放问卷，其中包括一种新的针对激素缺乏的、个体化的QoL问卷（HDQoL）、总体幸福感指数（GWBI）、幸福感问卷（W - BQ12）、简短健康状况调查问卷（SF - 36）、诺丁汉健康概况（NHP）和一般健康问卷（GHQ）。
基线后3个月，接受安慰剂治疗的患者血清总IGF - I从正常的、与年龄相关的水平（平均26.6±13.2 nmol/l）降至表明重度GHD的水平（11.6±6.6 nmol/l）（P<0.001）。在终点访谈中，接受安慰剂治疗的患者报告的GH撤药心理症状包括精力下降、疲劳、疼痛、易怒和抑郁增加。认为自己知道所接受治疗的患者在终点正确识别了治疗（GH或安慰剂）（χ2 = 11.25，P<0.01）。在SF - 36总体健康（P<0.01）、W - BQ12精力（P<0.01）和HDQoL身体方面（P<0.05）的变化评分中发现了显著的组间差异，表明与接受GH治疗的患者相比，在终点时安慰剂治疗组的总体健康状况下降、精力下降以及激素缺乏对身体能力的感知影响更大。
重度GHD成人停用GH治疗会产生有害的心理影响。
