Tabacco Gaia, Naciu Anda Mihaela, Cesareo Roberto, Maggi Daria, Pedone Claudio, Lelli Diana, Santonati Assunta, Bosco Daniela, Di Tommaso Alfonso Maria, Pozzilli Paolo, Manfrini Silvia, Palermo Andrea
Unit of Endocrinology and Diabetes, Department of Medicie, University Campus Bio-Medico, 00128, Rome, Italy.
Thyroid and Metabolic Bone Diseases Center, Department of Internal Medicine, S. Maria Goretti Hospital, 04100, Latina, Italy.
Endocrine. 2020 Jan;67(1):198-203. doi: 10.1007/s12020-019-02101-w. Epub 2019 Oct 3.
Hypoparathyroidism (hypoPT) results in an impairment of quality of life (QoL), an increase in fatigue and a higher risk of mortality. Cardiovascular autonomic neuropathy (CAN) is an impairment of the cardiovascular autonomic system and is associated with increased mortality and fatigability. Patients with hypoPT show an increased risk of CAN. However, no previous studies have investigated the association between CAN and QoL in hypoPT. To test whether CAN is associated with fatigue and impaired QOL in hypoPT patients.
We enrolled 48 subjects with postsurgical hypoPT treated with calcium and calcitriol and 38 healthy subjects who underwent thyroidectomy. Subjects completed the RAND 36-Item Short Form (SF-36) Health Survey, evaluating physical (PCS) and mental (MCS) health, and fatigue score. CAN was assessed using cardiovascular autonomic reflex tests (CARTs). Participants were considered to have "early CAN" (EC) if they had one abnormal CART and "definite CAN" (DC) with two or more abnormal CARTs.
Compared with controls, hypoPT population had lower fatigue scores (44.5 IQRː9 vs 38.5 IQRː12.3, P = 0.031). In the hypoPT group, only participants with DC had a lower fatigue score than subjects without CAN (DC: β: -9.55, P = 0.005) after adjusting for age, duration of disease, calcium concentration, TSH, calcitriol and calcium supplementation. No differences were found in the PCS and MCS scores in the hypoPT group.
CAN may explain fatigue, a common complaint of postsurgical hypoPT patients. Further larger and prospective investigations are needed to confirm our findings.
甲状旁腺功能减退症（甲旁减）会导致生活质量（QoL）受损、疲劳感增加以及更高的死亡风险。心血管自主神经病变（CAN）是心血管自主神经系统的一种损伤，与死亡率增加和易疲劳性相关。甲旁减患者发生CAN的风险增加。然而，此前尚无研究调查甲旁减患者中CAN与QoL之间的关联。旨在测试CAN是否与甲旁减患者的疲劳及QoL受损有关。
我们纳入了48例接受钙剂和骨化三醇治疗的术后甲旁减患者以及38例接受甲状腺切除术的健康受试者。受试者完成了兰德36项简明健康调查（SF-36），评估身体（PCS）和精神（MCS）健康状况以及疲劳评分。使用心血管自主反射测试（CARTs）评估CAN。如果参与者有一项CART异常，则被认为患有“早期CAN”（EC）；如果有两项或更多CART异常，则被认为患有“明确CAN”（DC）。
与对照组相比，甲旁减人群的疲劳评分更低（44.5四分位数间距：9 vs 38.5四分位数间距：12.3，P = 0.031）。在甲旁减组中，调整年龄、病程、钙浓度、促甲状腺激素、骨化三醇和钙剂补充后，只有患有DC的参与者的疲劳评分低于无CAN的受试者（DC：β：-9.55，P = 0.005）。甲旁减组的PCS和MCS评分未发现差异。
CAN可能解释了术后甲旁减患者常见的疲劳症状。需要进一步开展更大规模的前瞻性研究来证实我们的发现。
