Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457, Boston, MA, 02114, USA.
Harvard Medical School, Boston, MA, USA.
Pituitary. 2022 Jun;25(3):531-539. doi: 10.1007/s11102-022-01224-0. Epub 2022 Apr 27.
To assess long-term quality of life (QoL) in patients with sustained biochemical control of acromegaly, comparing those receiving vs not receiving pharmacotherapy (primary analysis); to assess change in QoL over time (secondary analysis).
Cross-sectional study, with a secondary longitudinal component, of 58 patients with biochemically controlled acromegaly. All had participated in studies assessing QoL years previously, after having undergone surgery ± radiotherapy. One cohort received medical therapy [MED (n = 33)]; the other did not [NO-MED (n = 25)]. QoL was assessed by the 36-Item-Short-Form Health Survey (SF-36), Acromegaly Quality of Life Questionnaire (AcroQoL), Gastrointestinal Quality of Life Index (GIQLI), Symptom Questionnaire, and QoL-Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA).
Mean (± SD) duration of biochemical control was 15.0 ± 6.4 years for MED and 20.4 ± 8.2 years for NO-MED (p = 0.007). 58% of subjects scored < 25% of normal on ≥ 1 SF-36 domain and 32% scored < 25% of normal on ≥ 4 of 8 domains. Comparing MED vs NO-MED and controlling for duration of biochemical control, there were no significant differences in QoL by SF-36, AcroQOL, GIQLI, Symptom Questionnaire, or QoL-AGHDA. Growth hormone deficiency (GHD) but not radiotherapy predicted poorer QoL. In MED, QoL improved over time in three AcroQoL domains and two GIQLI domains. In NO-MED, QoL worsened in two SF-36 domains and two Symptom Questionnaire domains; QoL-AGHDA scores also worsened in subjects with GHD.
A history of acromegaly and development of GHD, but not pharmacologic or radiotherapy, are detrimental to QoL, which remains poor over the long-term despite biochemical control.
评估长期生化控制的肢端肥大症患者的生活质量（QoL），比较接受和不接受药物治疗的患者（主要分析）；评估随时间变化的 QoL 变化（次要分析）。
对 58 例生化控制的肢端肥大症患者进行横断面研究，其中包括二次纵向部分。所有患者均曾参与过几年前评估 QoL 的研究，这些患者在接受手术治疗后±放疗。一组接受药物治疗[MED（n=33）]；另一组未接受治疗[NO-MED（n=25）]。使用 36 项简短健康调查问卷（SF-36）、肢端肥大症生活质量问卷（AcroQoL）、胃肠道生活质量指数（GIQLI）、症状问卷和成人生长激素缺乏症生活质量评估（QoL-AGHDA）来评估 QoL。
接受药物治疗组 MED 的生化控制平均时间为 15.0±6.4 年，NO-MED 为 20.4±8.2 年（p=0.007）。58%的患者在至少 1 个 SF-36 域中得分低于正常的 25%，32%的患者在 8 个域中的至少 4 个域中得分低于正常的 25%。比较 MED 与 NO-MED 并控制生化控制的持续时间，SF-36、AcroQOL、GIQLI、症状问卷或 QoL-AGHDA 的 QoL 无显著差异。生长激素缺乏症（GHD）但不是放疗预测 QoL 较差。在 MED 中，三个 AcroQoL 域和两个 GIQLI 域的 QoL 随时间改善。在 NO-MED 中，两个 SF-36 域和两个症状问卷域的 QoL 恶化；GHD 患者的 QoL-AGHDA 评分也恶化。
肢端肥大症病史和 GHD 的发生，但不是药物治疗或放疗，对 QoL 不利，尽管生化控制良好，但长期来看 QoL 仍然较差。
