Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota 55905, USA.
Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Clin Endocrinol Metab. 2022 Jun 16;107(7):e2851-e2861. doi: 10.1210/clinem/dgac175.
Current evidence on determinants of quality of life (QoL) in patients with adrenal insufficiency (AI) is limited.
This work aimed to identify the determinants of QoL in different subtypes of AI.
This multicenter cross-sectional survey study was conducted using a patient-centered questionnaire, the Short Form-36.
Of 529 participants, 223 (42.2%) had primary AI, 190 (35.9%) had secondary AI, and 116 (21.9%) had glucocorticoid-induced AI. Median age was 58 years (interquartile range: 43-68 years) and 342 (64.8%) were women. In multivariable analyses, patients were more likely to report worse physical scores if they were women (odds ratio [OR]: 3.3; 95% CI, 1.8-6.0), had secondary AI or glucocorticoid-induced AI (OR: 2.5; 95% CI, 1.4-4.3), had shorter duration of AI (OR: 2.0; 95% CI, 1.1-3.6), were treated with more than 25 mg hydrocortisone equivalent daily (OR: 2.3; 95% CI, 1.2-4.6), had more comorbidities related to glucocorticoid excess (OR: 2.3; 95% CI, 1.3-4.0), reported a higher financial burden from AI (OR: 2.1; 95% CI, 1.3-3.6), and reported difficulties with AI management (OR: 2.5; 95% CI, 1.2-5.2). Women (OR: 2.1; 95% CI, 1.08-4.0), shorter duration of AI (OR: 2.4; 95% CI, 1.4-4.3), higher financial burden (OR: 2.3; 95% CI, 1.3-4.0), difficulties with AI management (OR: 2.6; 95% CI, 1.4-4.9), and lack of family support (OR: 9.1; 95% CI, 2.3-33.3) were associated with worse mental component scores.
In patients with AI, QoL could be improved by addressing certain determinants, such as avoiding GC overreplacement, providing in-depth education on self-management, offering more comprehensive insurance coverage, and ensuring better family support.
目前关于肾上腺功能不全（AI）患者生活质量（QoL）决定因素的证据有限。
本研究旨在确定不同类型 AI 患者 QoL 的决定因素。
本多中心横断面调查研究使用以患者为中心的问卷，即健康调查简表 36 项（Short Form-36）进行。
在 529 名参与者中，223 名（42.2%）患有原发性 AI，190 名（35.9%）患有继发性 AI，116 名（21.9%）患有糖皮质激素诱导的 AI。中位年龄为 58 岁（四分位间距：43-68 岁），342 名（64.8%）为女性。多变量分析显示，如果患者为女性（比值比[OR]：3.3；95%置信区间[CI]：1.8-6.0）、患有继发性 AI 或糖皮质激素诱导的 AI（OR：2.5；95%CI：1.4-4.3）、AI 持续时间较短（OR：2.0；95%CI：1.1-3.6）、接受的氢化可的松当量每日剂量超过 25mg（OR：2.3；95%CI：1.2-4.6）、与糖皮质激素过量相关的合并症更多（OR：2.3；95%CI：1.3-4.0）、报告 AI 治疗费用负担更高（OR：2.1；95%CI：1.3-3.6）和 AI 管理困难（OR：2.5；95%CI：1.2-5.2），则更有可能报告较差的生理评分。女性（OR：2.1；95%CI：1.08-4.0）、AI 持续时间较短（OR：2.4；95%CI：1.4-4.3）、较高的经济负担（OR：2.3；95%CI：1.3-4.0）、AI 管理困难（OR：2.6；95%CI：1.4-4.9）、缺乏家庭支持（OR：9.1；95%CI：2.3-33.3）与较差的心理评分相关。
在 AI 患者中，通过避免糖皮质激素过度替代、提供深入的自我管理教育、提供更全面的保险覆盖范围以及确保更好的家庭支持等措施，可改善 QoL。
