Holmes S J, Shalet S M
Department of Endocrinology, Christie Hospital NHS Trust, Manchester, UK.
Clin Endocrinol (Oxf). 1995 Jun;42(6):613-8. doi: 10.1111/j.1365-2265.1995.tb02688.x.
It is possible that the degree of perceived well-being may influence the decision of an adult with GH deficiency to receive GH replacement. We have therefore sought factors which influenced whether or not such a patient wished to enter a study of GH replacement.
Biochemical, anthropometric and demographic characteristics, and well-being, of patients who chose to enter a 12-month study of GH replacement at Christie Hospital NHS Trust were compared with those of patients who declined to enter the study.
Sixty-five adults with GH deficiency who entered a study of GH replacement and 33 adults with GH deficiency who were approached but who declined to enter the study.
The two groups of patients were compared according to sex, age, height, weight, body mass index, peak serum GH response to provocative testing, estimated duration of GH deficiency, whether GH deficiency was of childhood or adult onset, presence or absence of additional pituitary hormone deficiencies, aetiology of GH deficiency, previous therapeutic interventions, employment status, marital status and living arrangement (65 entered vs 33 declined to enter). Well-being or distress was measured using the Nottingham Health Profile (NHP) (65 entered vs 20 declined to enter) and the Psychological General Well-being Schedule (PGWBS) (33 entered vs 19 declined to enter).
Those who entered the study had significantly higher scores on the energy (P = 0.03) and emotional reaction (P = 0.02) subsections and on the total score (P = 0.04) of the NHP, indicating greater distress, and had a significantly lower score (P = 0.009) on the vitality subsection of the PGWBS, again indicating greater distress. Those who entered the study had a significantly lower prevalence of non-functioning pituitary adenoma (P = 0.02) but there was no other difference in biochemical, anthropometric or demographic characteristics between the two groups.
Adults who enter a study of GH replacement exhibit greater distress on questionnaire assessment than those who decline to enter such a study. This bias must be considered when interpreting studies of the effect of GH replacement on well-being in adults.
幸福感程度可能会影响成年生长激素缺乏症患者接受生长激素替代治疗的决定。因此，我们探寻了影响此类患者是否愿意参与生长激素替代治疗研究的因素。
将选择在克里斯蒂医院国民保健服务信托基金参加为期12个月生长激素替代治疗研究的患者的生化、人体测量和人口统计学特征以及幸福感，与拒绝参加该研究的患者进行比较。
65名成年生长激素缺乏症患者参加了生长激素替代治疗研究，33名成年生长激素缺乏症患者收到邀请但拒绝参加该研究。
根据性别、年龄、身高、体重、体质指数、刺激试验后血清生长激素峰值反应、估计的生长激素缺乏持续时间、生长激素缺乏是儿童期还是成年期发病、是否存在其他垂体激素缺乏、生长激素缺乏的病因、既往治疗干预、就业状况、婚姻状况和生活安排，对两组患者进行比较（65名参加者与33名拒绝参加者）。使用诺丁汉健康量表（NHP）（65名参加者与20名拒绝参加者）和心理总体幸福感量表（PGWBS）（33名参加者与19名拒绝参加者）测量幸福感或痛苦程度。
参加研究的患者在NHP的精力（P = 0.03）和情绪反应（P = 0.02）子量表以及总分（P = 0.04）上得分显著更高，表明痛苦程度更大，并且在PGWBS的活力子量表上得分显著更低（P = 0.009），同样表明痛苦程度更大。参加研究的患者无功能性垂体腺瘤的患病率显著更低（P = 0.02），但两组在生化、人体测量或人口统计学特征方面无其他差异。
参加生长激素替代治疗研究的成年人在问卷调查评估中表现出比拒绝参加此类研究的成年人更大的痛苦。在解释生长激素替代治疗对成年人幸福感影响的研究时，必须考虑这种偏差。
