Center for Psychosocial Medicine, Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Division Paediatric Endocrinology, Hospital for Children and Adolescents, University Erlangen-Nürnberg, Erlangen, Germany.
J Endocrinol Invest. 2019 Sep;42(9):1067-1076. doi: 10.1007/s40618-019-01027-4. Epub 2019 Mar 6.
Little attention has been directed towards examining the impact of predictors on change in health-related quality of life (HRQOL) within the course of growth hormone (GH) treatment in pediatric short stature. We aimed to assess changes in HRQOL and its sociodemographic, clinical and psychosocial predictors in children and adolescents diagnosed with growth hormone deficiency (GHD), and born short for gestational age (SGA) before and 12-month after start of GH treatment from the parents' perspective. Results were compared with an untreated group with idiopathic short stature (ISS). In this prospective multicenter study, 152 parents of children/adolescents (aged 4-18 years) provided data on their children's HRQOL at baseline and at 12-month follow-up.
Repeated-measures multivariate analyses of covariance were performed to examine parent-reported HRQOL changes from baseline to 1-year after treatment and hierarchical linear regressions to identify the predictors of HRQOL changes.
Results showed that parents of children that were treated with GH report an increase in their children's HRQOL after 1 year. Changes in HRQOL were mostly explained by psychosocial predictors followed by sociodemographic and clinical variables. Specifically, the diagnosis SGA significantly predicted a greater increase in parent-reported HRQOL. Furthermore, a lower caregiving burden significantly predicted a decrease in parent-reported HRQOL.
In conclusion, a substantial percentage of explained variance in HRQOL relates to psychosocial and sociodemographic predictors. However, there appears to be other important factors that are predictors of HRQOL, which need to be determined in large, population-based samples.
在儿科身材矮小患者接受生长激素（GH）治疗过程中，人们很少关注预测因素对健康相关生活质量（HRQOL）变化的影响。我们旨在评估从父母的角度评估患有生长激素缺乏症（GHD）和因胎龄较小而身材矮小（SGA）的儿童和青少年在开始 GH 治疗前后 HRQOL 及其社会人口统计学、临床和心理社会预测因素的变化。将结果与未经治疗的特发性身材矮小（ISS）组进行比较。在这项前瞻性多中心研究中，152 名儿童/青少年（年龄 4-18 岁）的父母提供了基线和 12 个月随访时其子女 HRQOL 的数据。
采用重复测量多元协方差分析来检查从基线到治疗后 1 年父母报告的 HRQOL 变化，并进行分层线性回归以确定 HRQOL 变化的预测因素。
结果表明，接受 GH 治疗的儿童的父母报告在治疗 1 年后其子女的 HRQOL 有所提高。HRQOL 的变化主要由心理社会预测因素解释，其次是社会人口统计学和临床变量。具体来说，SGA 诊断显著预测了父母报告的 HRQOL 更大的增加。此外，较低的护理负担显著预测了父母报告的 HRQOL 的降低。
总之，HRQOL 中很大一部分可解释的差异与心理社会和社会人口统计学预测因素有关。然而，似乎还有其他重要的因素是 HRQOL 的预测因素，这需要在大型、基于人群的样本中确定。
