Gu Jing, Xiang Shiyuan, He Min, Wang Meng, Gu Yanfang, Li Lingjuan, Yin Zhiwen
Department of Nursery, Huashan Hospital, Fudan University, Shanghai 200040, China.
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China.
Int J Endocrinol. 2020 Aug 4;2020:5363849. doi: 10.1155/2020/5363849. eCollection 2020.
We aimed to determine the perioperative changes in the quality of life (QoL) in patients with acromegaly and to reveal the relationship between biochemical indicators and quality of life change after tumor resection.
Patients with acromegaly were enrolled from a tertiary pituitary center. SF-36 scale and AcroQoL scale were used to determine the QoL before and after surgery. We analyzed changes in QoL using a generalized linear model for repeated measurements. We compared the changes in QoL among three groups (remission, active, and discordant group) based on postoperative growth hormone (GH) and insulin-like growth factor-1.
151 patients (75 males and 76 females) diagnosed with acromegaly were included. The average age was 43.9 ± 12.3 years. The median total SF-36 scale was 65.3% (IQR: 63.2%-69.2%). Overall AcroQoL score at baseline was 59.1% (IQR: 51.8%-71.8%). Nadir GH levels (coefficient -0.08, =0.047), T3 levels (coefficient 2.8, =0.001), and testosterone levels (coefficient -0.20, =0.033) in males were independent predictive factors of the total SF-36 score. During the follow-up, the median overall SF-36 score increased to 66.1% at 3 months and 75.3% at 6 months ( < 0.001) after surgery. The median overall AcroQoL score increased to 74.5% at 3 months and 77.3% at 6 months ( < 0.001) after surgery. At 6-month follow-up, median scores were still less than 70% in appearance, vitality, and mental health dimensions. The QoL after surgery were similar among the three groups, although higher GH and more preoperative somatostatin analogs usage were observed in the active group.
In conclusion, acromegalic patients were associated with low QoL, which could be reversed partially by surgery. The improvement was independent of the endocrine remission. Appearance, vitality, and mental health were three major aspects that warrant further attention from physicians and caregivers after surgery.
我们旨在确定肢端肥大症患者围手术期生活质量（QoL）的变化，并揭示肿瘤切除后生化指标与生活质量变化之间的关系。
从一家三级垂体中心招募肢端肥大症患者。使用SF-36量表和肢端肥大症生活质量量表（AcroQoL）来确定手术前后的生活质量。我们使用广义线性模型进行重复测量来分析生活质量的变化。我们根据术后生长激素（GH）和胰岛素样生长因子-1，比较了三组（缓解组、活动组和不一致组）生活质量的变化。
纳入151例诊断为肢端肥大症的患者（75例男性和76例女性）。平均年龄为43.9±12.3岁。SF-36量表总分中位数为65.3%（四分位间距：63.2%-69.2%）。基线时AcroQoL量表总分中位数为59.1%（四分位间距：51.8%-71.8%）。男性的最低GH水平（系数-0.08，P=0.047）、T3水平（系数2.8，P=0.001）和睾酮水平（系数-0.20，P=0.033）是SF-36量表总分的独立预测因素。随访期间，术后3个月SF-36量表总分中位数增至66.1%，6个月时增至75.3%（P<0.001）。术后3个月AcroQoL量表总分中位数增至74.5%，6个月时增至77.3%（P<0.001）。在6个月随访时，外貌、活力和心理健康维度的中位数得分仍低于70%。三组术后的生活质量相似，尽管活动组的GH水平较高且术前使用生长抑素类似物的情况较多。
总之，肢端肥大症患者的生活质量较低，手术可使其部分逆转。这种改善与内分泌缓解无关。外貌、活力和心理健康是术后医生和护理人员需要进一步关注的三个主要方面。
