Impaired quality of life in patients with treated acromegaly despite long-term biochemically stable disease: Results from a 5-years prospective study
Impaired quality of life in patients with treated acromegaly despite long-term biochemically stable disease: Results from a 5-years prospective study
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DOI：
10.1111/cen.13331
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发表时间：
2017-06-01
影响因子：
3.2
通讯作者：
Murray, Robert D.
中科院分区：
文献类型：
--
作者：
Kyriakakis, Nikolaos;Lynch, Julie;Murray, Robert D.
目的：肢端肥大症患者的生活质量(QOL)受损，但有关治疗后的长期QOL变化的数据有限。这项研究评估和确定了影响长期生化缓解患者生活质量的因素。设计：研究包括横断面手臂，比较治疗和控制肢端肥大症患者与健康对照组之间的生活质量；纵向手臂，评估5.7+/-0.6年间生化稳定型疾病患者的生活质量变化。患者：横断面手臂招募了58名患者和116名匹配的对照组；采用3种通用问卷(心理一般幸福量表[PGWBS]、36项简表[SF-36]、EuroQol[EQ-5D])和疾病特异性肢端肥大症生活质量问卷(AcroQL)。结果：肢端肥大症诊断和治疗11.6±8.2年后进行生活质量评估。接受治疗的肢端肥大症患者在所有问卷中的生活质量得分均低于对照组，但PGWBS的“焦虑”子量表除外。其余问卷的AcroQOL“外表”子量表和“身体功能”子量表是最受重视的领域。所有问卷的总分和分量表得分在基线和随访期间均无差异，但SF-36“身体功能”得分下降(58.5+/-24.7%比43.1+/-31.1%；P=0.002)。然而，在调整协变量后，生活质量得分中的任何一个都没有显著变化。在基线时，IGF-1/GH控制时间与大多数问卷中的QOL得分呈正相关，而在QOL评估时使用GH降低治疗是QOL的负面预测因素。结论：生化控制的肢端肥大症患者存在QOL受损，尽管进行了长期的疾病控制，但这种损害仍然存在。这主要包括身体功能受损，其次是心理社会福祉受损。生化疾病控制时间和目前使用的GH降糖治疗是影响患者生活质量的主要因素。
Objective: Patients with acromegaly demonstrate impaired quality of life (QoL), but data on long-term QoL changes in treated acromegaly are limited. This study evaluates and identifies factors that influence QoL in patients with long-term biochemical remission.Design: The study consists of a cross-sectional arm comparing QoL between patients with treated and controlled acromegaly and healthy controls; and a longitudinal arm assessing QoL changes in patients with biochemically stable disease during 5.7 +/- 0.6 years of follow-up.Patients: A total of 58 patients and 116 matched controls were recruited for the cross-sectional arm; 28 patients completed the longitudinal arm.Measurements: Three generic questionnaires (Psychological General Well-Being Schedule [PGWBS], 36-item Short-Form [SF-36], EuroQoL [EQ-5D]) and the disease-specific acromegaly QoL questionnaire (AcroQoL) were applied.Results: Quality of life assessment was performed 11.6 +/- 8.2 years following diagnosis and treatment of acromegaly. Patients with treated acromegaly had lower QoL scores compared with controls in all questionnaires with the exception of the PGWBS "Anxiety" subscale. The AcroQoL "Appearance" subscale and the "Physical Function" subscales of the remaining questionnaires were the most underscored domains. No difference in the total and subscale scores of all questionnaires was observed between baseline and follow-up, with the exception of the SF-36 "Physical Function," where a decline was found (58.5 +/- 24.7% vs 43.1 +/- 31.1%; P=.002). However, after adjusting for covariates, no significant change in any of the QoL scores was seen. Duration of IGF-1/GH control was positively correlated with QoL scores in most questionnaires at baseline, whereas use of GH lowering therapy at the time of QoL assessment was a negative predictive factor of QoL.Conclusion: Patients with biochemically controlled acromegaly demonstrate impaired QoL, which persists despite long-term disease control. This primarily consists of impaired physical function and secondly of impaired psycho-social well-being. Duration of biochemical disease control and current use of GH lowering therapy was the predominant factors determining patients' QoL.