Long-term impaired quality of life in Cushing's syndrome despite initial improvement after surgical remission
Long-term impaired quality of life in Cushing's syndrome despite initial improvement after surgical remission
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DOI：
10.1210/jc.2005-1058
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发表时间：
2006-02-01
影响因子：
5.8
通讯作者：
Nieman, LK
中科院分区：
文献类型：
--
作者：
Lindsay, JR;Nansel, T;Nieman, LK
内容：库欣氏综合征（CS）的症状可能会影响健康相关生活质量（HRQL）。方法：我们采用简明36项调查表评估23例库欣氏病患者经蝶窦手术前后的HRQL（年龄，42.7 +/- 12.0岁; 19名女性和4名男性）和343名CS患者的横断面（年龄，48.2 ± 14.1岁; 265名女性和78名男性）手术后缓解长达25.8年（肾上腺，5%;异位，6%）。计算简明36个领域的z分数，并将身体（PCS）和精神（MCS）总分与年龄和性别匹配的对照组（n = 6742）进行比较。尽管术后仍有损伤，主要是身体部位，但经蝶手术治疗后所有HRQL参数均有所改善（3.2 ± 1.5年; P < 0.05）。在随访缓解期的横断面中，PCS和MCS均存在较小但显著（P < 0.05）的损害。纵向术后分析证实，HRQL随时间推移稳定，但受损。Logistic回归分析表明，以前的垂体辐射和目前的糖皮质激素的使用HRQL outcomes.Conclusion的影响不大：CS与受损HRQL，治疗后部分解决。然而，在长期随访中，HRQL仍有残留损害。确定可改变的因素，有助于受损的HRQL可能有助于减少这种疾病的身体和心理负担。
Context: Cushing's syndrome ( CS) is associated with symptoms that may impair health-related quality of life (HRQL).Methods: We used the short-form 36 survey to evaluate HRQL in 23 patients with Cushing's disease before and after transsphenoidal surgery ( age, 42.7 +/- 12.0 yr; 19 women and four men) and in a cross-section of 343 CS patients ( age, 48.2 +/- 14.1 yr; 265 women and 78 men) in remission for up to 25.8 yr after surgery ( adrenal, 5%; ectopic, 6%). The z-scores were calculated for short-form 36 domains, and physical (PCS) and mental (MCS) summary scores were compared with those of age- and sex-matched controls (n = 6742).MCS scores ( P < 0.05). Despite residual postoperative impairment, primarily of physical domains, all HRQL parameters improved after treatment with transsphenoidal surgery ( 3.2 +/- 1.5 yr; P < 0.05). In the cross-section in remission at follow-up, there was a small, but significant ( P < 0.05), impairment of both PCS and MCS. A longitudinal postoperative analysis confirmed stable, but impaired, HRQL over time. Logistic regression demonstrated that previous pituitary radiation and current glucocorticoid use had little effect on HRQL outcomes.Conclusion: CS is associated with impaired HRQL, which partially resolves after treatment. At longer-term follow-up, however, there is residual impairment of HRQL. Determination of modifiable factors that contribute to impaired HRQL may help reduce the physical and psychosocial burden of this disease.