氢化可的松与泼尼松治疗对内源性高皮质醇症患者术后恢复的影响:一项前瞻性队列研究

IF 5.3 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Rashi Sandooja, Jasmine Saini, Elio Ferreira Taveras, Raul Gregg-Garcia, Catherine D Zhang, Vanessa Fell, Anina Peersen, Sara J Achenbach, Elizabeth J Atkinson, Jamie J Van Gompel, William F Young, Irina Bancos
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引用次数: 0

摘要

目的:糖皮质激素戒断综合征(GWS)可能发生在内源性高糖血症患者手术成功后。目前缺乏减少GWS和提高生活质量(QoL)的有效策略。我们的目的是确定氢化可的松与泼尼松治疗对术后前12周GWS和QoL的影响。方法:单中心前瞻性队列研究(2019-2024),研究对象为内源性高皮质醇症患者,术后发生肾上腺功能不全,接受强的松或氢化可的松治疗。在基线和术后12周采用SF-36和Cushing生活质量问卷评估生活质量。术后前12周使用每周AddiQoL问卷评估GWS。结果:165例患者中,101例(61%)采用氢化可的松治疗,64例(39%)采用强的松治疗。基线时,在高皮质醇症亚型、合并症或生活质量评估方面没有发现组间差异。在随访中,最终每日氢化可的松等效总剂量未见组间差异。当调整基线生活质量评估时,接受泼尼松治疗的患者表现出更高程度的生活质量改善,特别是在SF-36精神成分评分(估计0.33,95%CI 0.04-0.63), SF-36角色情绪限制(估计0.52,95%CI 0.2-0.84)和SF-36身体疼痛(估计0.31,95%CI 0.07-0.56)亚成分方面。在年龄、性别、BMI、糖皮质激素类型、基线临床严重程度评分和基线生活质量评估的多变量分析中,强的松治疗是术后12周更好的SF-36精神成分的独立预测因子。结论:与氢化可的松治疗相比,强的松治疗可改善高皮质醇患者术后12周的心理健康生活质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of hydrocortisone vs prednisone therapy on postsurgical recovery in patients with endogenous hypercortisolism: a prospective cohort study.

Objective: Glucocorticoid withdrawal syndrome (GWS) may develop in patients following successful surgery for endogenous hypercortisolism. Effective strategies to minimize GWS and improve quality of life (QoL) are currently lacking. We aimed to determine the impact of hydrocortisone vs prednisone therapy on GWS and QoL during the first 12 weeks postsurgery.

Methods: Single-center prospective cohort study (2019-2024) of adults with endogenous hypercortisolism who developed postoperative adrenal insufficiency and treated with either prednisone or hydrocortisone. Quality of life was assessed with Short Form-36 (SF-36) and Cushing QoL questionnaires at baseline and at 12 weeks postsurgery. GWS was assessed using weekly AddiQoL questionnaires for the first 12 weeks postsurgery.

Results: Of 165 patients, 101 (61%) were treated with hydrocortisone and 64 (39%) with prednisone. At baseline, no group differences were found in the hypercortisolism subtype, comorbidities, or QoL assessments. At follow-up, no group differences in final total daily hydrocortisone equivalent dose were seen.When adjusting for the baseline QoL assessment, patients treated with prednisone demonstrated a higher degree of improvement in their QoL, particularly in the SF-36 mental component score (estimate 0.33, 95% CI, 0.04-0.63), SF-36 role-emotional limitation (estimate 0.52, 95% CI, 0.2-0.84), and SF-36 body pain (estimate 0.31, 95% CI, 0.07-0.56) subcomponents. In the multivariable analysis of age, sex, body mass index, glucocorticoid type, baseline clinical severity score, and baseline QoL assessment, prednisone therapy was an independent predictor of better SF-36 mental component at 12 weeks postsurgery.

Conclusions: Prednisone therapy was associated with better mental health QoL than hydrocortisone at 12 weeks postsurgery in patients with hypercortisolism.

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来源期刊
European Journal of Endocrinology
European Journal of Endocrinology 医学-内分泌学与代谢
CiteScore
9.80
自引率
3.40%
发文量
354
审稿时长
1 months
期刊介绍: European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica. The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology. Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials. Equal consideration is given to all manuscripts in English from any country.
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