Solomon B L, Schaaf M, Smallridge R C
Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, D.C. 20307-5001.
Am J Med. 1994 Feb;96(2):101-6. doi: 10.1016/0002-9343(94)90128-7.
To identify in an outpatient setting the type and number of psychologic symptoms of patients with primary hyperparathyroidism before and after surgery.
A convenience sample of 18 patients with primary hyperparathyroidism and a comparison sample of 20 patients with benign thyroid disease were scheduled by their primary care physician to have surgery. Assessments of psychologic symptoms, using the Symptom Checklist-90-Revised, and measurements of serum total calcium, ionized calcium, parathyroid hormone, albumin, alkaline phosphatase, urea nitrogen, creatinine, protein, and phosphate were obtained preoperatively. and at 1, 3, and 6 months postoperatively.
The hyperparathyroid group had significantly higher (p < 0.01) levels of total and ionized serum calcium and parathyroid hormone preoperatively, with biochemical normalization 1 month postoperatively. These patients showed multidimensional psychologic symptom distress preoperatively in the areas of obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and psychoticism; they also had a greater number and intensity of distressful symptoms. Paranoid ideation was significantly higher in the hyperparathyroid group than in the comparison group, but it did not quite reach the clinical range. The greatest improvement in symptoms occurred by 1 month after surgery, with the hyperparathyroid group approaching the normative mean. There were no group differences before or after surgery for the areas of somatization and phobic anxiety.
The Symptom Checklist-90-Revised is a simple, quick, and cost-effective way to quantitatively assess the psychologic symptoms of patients with primary hyperparathyroidism. We found that psychologic symptom distress is multidimensional, that symptoms had profoundly improved by 1 month after parathyroidectomy, and that somatization and anxiety did not differ between our groups.
在门诊环境中确定原发性甲状旁腺功能亢进症患者手术前后心理症状的类型和数量。
18例原发性甲状旁腺功能亢进症患者的便利样本以及20例良性甲状腺疾病患者的对照样本由其初级保健医生安排进行手术。术前、术后1个月、3个月和6个月使用症状自评量表90修订版对心理症状进行评估，并测量血清总钙、离子钙、甲状旁腺激素、白蛋白、碱性磷酸酶、尿素氮、肌酐、蛋白质和磷酸盐。
甲状旁腺功能亢进组术前血清总钙、离子钙和甲状旁腺激素水平显著更高（p<0.01），术后1个月生化指标恢复正常。这些患者术前在强迫观念与行为、人际敏感、抑郁、焦虑、敌对和精神病性等方面表现出多维度的心理症状困扰；他们的痛苦症状数量更多、强度更大。甲状旁腺功能亢进组的偏执观念显著高于对照组，但尚未达到临床范围。症状改善最明显的是术后1个月，甲状旁腺功能亢进组接近正常均值。在躯体化和恐惧性焦虑方面，手术前后两组之间没有差异。
症状自评量表90修订版是一种简单、快速且经济有效的方法，可用于定量评估原发性甲状旁腺功能亢进症患者的心理症状。我们发现心理症状困扰是多维度的，甲状旁腺切除术后1个月症状有显著改善，且我们两组之间在躯体化和焦虑方面没有差异。
