Cheng Shih-Ping, Lee Jie-Jen, Liu Tsang-Pai, Yang Po-Sheng, Liu Sung-Chen, Hsu Yi-Chiung, Liu Chien-Liang
From the Department of Surgery, MacKay Memorial Hospital and Mackay Medical College (S-PC, J-JL, T-PL, P-SY, C-LL); Division of Endocrinology and Metabolism, Department of Medicine, MacKay Memorial Hospital and Mackay Medical College (S-CL); Mackay Junior College of Medicine, Nursing, and Management (J-JL, T-PL, S-CL, C-LL); Department of Pharmacology and Graduate Institute of Medical Sciences, Taipei Medical University (S-PC, J-JL); and Institute of Statistical Science, Academia Sinica, Taipei, Taiwan (Y-CH).
Medicine (Baltimore). 2015 Jun;94(23):e931. doi: 10.1097/MD.0000000000000931.
A number of studies have investigated the effects of surgery on symptoms and quality of life in patients with hyperparathyroidism. However, the results are inconsistent. We conducted this meta-analysis to quantitatively assess changes in quality of life among patients with asymptomatic primary hyperparathyroidism. Different databases were searched for randomized controlled trials comparing surgery with surveillance. Quality of life was measured by the Short Form-36 general health survey. The pooled random-effects estimates of standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated. Three trials involving 294 participants were included. At 1 year, patients undergoing parathyroidectomy had significantly better physical role functioning (SMD, 0.31; 95% CI 0.04-0.57; P = 0.02) and emotional role functioning (SMD, 0.29; 95% CI 0.02-0.55; P = 0.03). At 2 years, the surgery group had significantly better emotional role functioning (SMD, 0.35; 95% CI 0.02-0.67; P = 0.04) than the surveillance group. Furthermore, compared with baseline, emotional role functioning improved after surgery (SMD, 0.31; 95% CI 0.02-0.60; P = 0.04), whereas emotional role functioning tended to get worse in patients assigned to medical surveillance (SMD, -0.27; 95% CI -0.55 to 0.02; P = 0.07). Although Short Form-36 is a generic instrument, our results suggest that parathyroidectomy may be associated with better quality of life, especially in the emotional aspects of well-being.
多项研究调查了手术对甲状旁腺功能亢进患者症状及生活质量的影响。然而，结果并不一致。我们进行了这项荟萃分析，以定量评估无症状原发性甲状旁腺功能亢进患者生活质量的变化。检索了不同数据库以查找比较手术与监测的随机对照试验。生活质量通过简短健康调查问卷-36进行测量。计算了标准化均数差（SMD）和95%置信区间（CI）的合并随机效应估计值。纳入了三项涉及294名参与者的试验。在1年时，接受甲状旁腺切除术的患者在身体角色功能（SMD，0.31；95%CI 0.04 - 0.57；P = 0.02）和情感角色功能（SMD，0.29；95%CI 0.02 - 0.55；P = 0.03）方面显著更好。在2年时，手术组在情感角色功能方面（SMD，0.35；95%CI 0.02 - 0.67；P = 0.04）比监测组显著更好。此外，与基线相比，手术后情感角色功能有所改善（SMD，0.31；95%CI 0.02 - 0.60；P = 0.04），而分配到医学监测的患者情感角色功能有变差的趋势（SMD，-0.27；95%CI -0.55至0.02；P = 0.07）。尽管简短健康调查问卷-36是一种通用工具，但我们的结果表明甲状旁腺切除术可能与更好的生活质量相关，尤其是在幸福的情感方面。
