Mihai Radu, Sadler Gregory P
Department of Endocrine Surgery, level 2, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
World J Surg. 2008 May;32(5):807-14. doi: 10.1007/s00268-008-9509-9.
Parathyroidectomy for primary hyperparathyroidism (PHPT) is expected to trigger an improvement in the quality of life. This has been demonstrated previously by using the SF-36 questionnaire, whose interpretation is difficult in routine clinical practice. As an alternative, the 13-item questionnaire developed by Pasieka et al. can be used to assess the severity of symptoms on a visual analogue from which a parathyroid assessment of symptoms score (PAS) can be calculated. The purpose of this study was to correlate results of these two assessment tools.
Prospective case-series study recruiting consecutive unselected patients who underwent successful parathyroidectomy for PHPT. SF-36(v2) and Pasieka's questionnaires were collected before parathyroidectomy and at 3, 6, and 12 months postoperatively.
Between November 2005 and December 2006, 101 patients were diagnosed with PHPT (30 men; aged 18-89 years). Preoperative PAS ranged 0-1040 and did not correlate with the severity of hypercalcemia (2.91+/-0.25; range, 2.56-3.4 mmol/l). Scores from the SF-36 questionnaire were under the 50th percentile for the normal population in three domains (vitality, emotional role, and physical role). Minimally invasive parathyroidectomy was performed in 69 patients and bilateral cervical exploration in 32 patients. All were found to have a single parathyroid adenoma and were normocalcemic at 3-12 months after parathyroidectomy. At follow-up, there was a significant reduction of PAS from 460+/-257 preoperatively to 254+/-234 at 3 months postoperatively (n=72), to 245+/-215 at 6 months (n=50), and 249+/-212 at 12 months (n=63) (p<0.05, Student's t-test). There was a significant and persistent improvement in five domains of SF-36 questionnaire: bodily pain, general health, vitality, social functioning and mental health. Overall analysis of 244 assessments using both questionnaires demonstrated a negative correlation between increasing PAS and decreasing mental component scores and physical component scores of the SF-36 assessment (r2=0.372 and 0.301, respectively).
Pasieka's parathyroid assessment of symptom scores (PAS) correlate with SF-36 questionnaire scores. Because PAS allows easier and faster analysis, we advocate that Pasieka's questionnaire should be integrated into the assessment of patients with PHPT as a reliable tool to identify symptomatic changes that correlate with improved quality of life.
原发性甲状旁腺功能亢进症（PHPT）的甲状旁腺切除术有望改善生活质量。此前使用SF - 36问卷已证实了这一点，但在常规临床实践中其解读存在困难。作为替代方法，Pasieka等人开发的13项问卷可用于通过视觉模拟量表评估症状严重程度，并据此计算甲状旁腺症状评估得分（PAS）。本研究的目的是关联这两种评估工具的结果。
前瞻性病例系列研究，纳入连续的未经过筛选且成功接受PHPT甲状旁腺切除术的患者。在甲状旁腺切除术前以及术后3个月、6个月和12个月收集SF - 36（v2）问卷和Pasieka问卷。
2005年11月至2006年12月期间，101例患者被诊断为PHPT（30例男性；年龄18 - 89岁）。术前PAS范围为0 - 1040，与高钙血症严重程度（2.91±0.25；范围2.56 - 3.4 mmol/L）无相关性。SF - 36问卷得分在正常人群第50百分位数以下的有三个领域（活力、情感角色和身体角色）。69例患者接受了微创甲状旁腺切除术，32例患者接受了双侧颈部探查术。所有患者均发现有单个甲状旁腺腺瘤，甲状旁腺切除术后3 - 12个月血钙正常。随访时，PAS从术前的460±257显著降低至术后3个月的254±234（n = 72），6个月时为245±215（n = 50），12个月时为249±212（n = 63）（p < 0.05，Student t检验）。SF - 36问卷的五个领域有显著且持续的改善：身体疼痛、总体健康、活力、社会功能和心理健康。使用这两种问卷对244次评估进行的总体分析表明，PAS升高与SF - 36评估的心理成分得分和身体成分得分降低之间存在负相关（r²分别为0.372和0.301）。
Pasieka的甲状旁腺症状评估得分（PAS）与SF - 36问卷得分相关。由于PAS分析更简便快捷，我们主张将Pasieka问卷纳入PHPT患者的评估中，作为一种可靠工具来识别与生活质量改善相关的症状变化。
