Clinical Endocrinology, Charité Campus Mitte, Charité University Medicine Berlin, Berlin, Germany.
Clin Endocrinol (Oxf). 2010 Mar;72(3):297-304. doi: 10.1111/j.1365-2265.2009.03596.x.
Recent studies suggest that current glucocorticoid replacement therapies fail to completely restore well-being in patients with adrenal insufficiency (AI).
The objective of this study was to investigate health-related quality of life (QoL) in patients with AI depending on dose and frequency of daily intake of hydrocortisone (HC).
In a cross-sectional study, primary and secondary AI patients were contacted and asked to complete three validated self-assessment questionnaires [Short Form-36 (SF-36), Giessen Complaint List (GBB-24), Hospital Anxiety and Depression Scale (HADS)]. HC doses were corrected for body surface area. Results were compared with sex- and age-matched controls drawn from the questionnaire-specific reference cohort.
Completed questionnaire sets were available from 334 patients on HC (primary AI n = 194; secondary AI n = 140). Patients on higher doses of HC (>30 mg/day) showed significantly impaired subjective health status in two of eight SF-36 dimensions, and three of five GBB-24 scales compared with those on lower HC doses. No significant differences in QoL were found between lower HC doses (15-30 mg/day) or between primary or secondary AI. Patients on HC with thrice daily intake showed significantly impaired QoL in one of eight SF-36 dimensions (15-20 mg/day, 20-25 mg/day), in one of five GBB-24 scales (15-20 mg/day), as well as higher anxiety scores.
Health-related QoL was impaired in patients with primary and secondary AI. HC doses above 30 mg/day were associated with a worse health status. Thrice daily intake of HC was not superior to twice daily intake. Our data support the perception that current replacement strategies are still insufficient to fully restore well-being and daily performance.
最近的研究表明，目前的糖皮质激素替代疗法未能完全恢复肾上腺功能不全（AI）患者的幸福感。
本研究旨在探讨 AI 患者的健康相关生活质量（QoL）取决于氢化可的松（HC）的每日剂量和频率。
在一项横断面研究中，联系了原发性和继发性 AI 患者，并要求他们完成三个经过验证的自我评估问卷[短表 36（SF-36），吉森抱怨清单（GBB-24），医院焦虑和抑郁量表（HADS）]。HC 剂量按体表面积校正。结果与从问卷特定参考队列中抽取的性别和年龄匹配的对照组进行比较。
334 名接受 HC 治疗的患者完成了问卷（原发性 AI n = 194；继发性 AI n = 140）。与接受低剂量 HC（<30 mg/天）的患者相比，接受高剂量 HC（>30 mg/天）的患者在八个 SF-36 维度中的两个维度和五个 GBB-24 量表中的三个维度中表现出明显受损的主观健康状况。在低剂量 HC（15-30 mg/天）或原发性或继发性 AI 之间，QoL 无显著差异。每日三次服用 HC 的患者在八个 SF-36 维度中的一个维度（15-20 mg/天，20-25 mg/天），五个 GBB-24 量表中的一个维度（15-20 mg/天），以及更高的焦虑评分中表现出明显受损的 QoL。
原发性和继发性 AI 患者的健康相关 QoL 受损。每天剂量超过 30 mg 的 HC 与更差的健康状况相关。每日三次服用 HC 并不优于每日两次服用。我们的数据支持当前替代策略仍不足以完全恢复幸福感和日常表现的观点。
