【作者】 杨智；

【导师】 徐广明；

【作者基本信息】 山东大学 ， 临床医学（专业学位）， 2012， 硕士

【摘要】 垂体泌乳素腺瘤是临床中最常见的垂体肿瘤亚型,多发生于青壮年,女性多见,多数腺瘤生长缓慢,病程长且多为良性经过,严重影响患者的生理和心理健康。药物和手术都可对垂体泌乳素腺瘤进行有效的治疗,但这两种治疗方式对患者生活质量的影响目前尚无研究,本研究旨在对不同治疗方式对泌乳素腺瘤患者生活质量的影响进行调查分析,以期对临床决策提供建设性意见。研究目的测量SF-36量表在国内泌乳素腺瘤患者中使用的信度和效度；了解目前泌乳素腺瘤患者治疗后的生活质量情况；药物和手术治疗后泌乳素腺瘤患者生活质量的对比及影响因素；为泌乳素腺瘤治疗方案的选择提供依据,同时为治疗后患者的健康教育提供指导。资料与方法收集2011年4月-2012年4月期间治疗的105例垂体泌乳素腺瘤患者,其中药物治疗组55例和手术治疗组50例,共计105例。用一般情况调查问卷收集患者的人口学资料及临床资料,用SF-36问卷调查患者治疗后的生活质量。每位病人治疗后均随访半年以上,主要采用门诊复查时现场请患者自行填写问卷,结合电话随访,电子邮件,邮寄问卷等多种方法采集资料,均要求患者本人回答填写。用SPSS16.0软件进行数据处理,量表信度用克朗巴赫α系数(Cronbach’s alpha coefficient, Cronbach’ s a)检测,量表的结构效度用因子分析,两组患者人口学资料和医疗资料的比较用t检验或x2检验,我国患者QOL与常模的比较采用单样本t检验,两组QOL的比较采用两样本t检验。结果1.SF-36量表总的克朗巴赫α系数为0.864。结构效度的测量采用主成分分析最大正交旋转法,共提取出9个公因子,累积解释69.25%的方差,经检验显示效度较好。2.泌乳素腺瘤患者的生活质量和常模相比,SF-36量表中的PF和常模没有显著差异(P>0.05)；泌乳素腺瘤患者的RP、 BP、 GH、 SF、RE得分比常模低,有统计学意义(P<0.05)；VT和MH高于常模,差异有统计学意义(P<0.05)。3.药物组和手术组的生活质量相比,两组SF-36量表评分中的PF、 RP、 GH、RE4个方面无显著差异(P>0.05)；药物组的BP、 VT、 MH3个方面评分低于手术组,差异有统计学意义(P<0.05)；药物组的SF方面评分高于手术组,差异有统计学意义(P<0.05)。4.女性泌乳素微腺瘤患者药物组和手术组在PF、 RP、 GH、 VT、 SF5个方面的评分无显著差异(P>0.05)；药物组的BP、 RE、 MH方面的评分低于手术组,差异有统计学意义(P<0.05)。女性泌乳素大腺瘤患者药物组和手术组的评分在各维度均无显著差异(P>0.05)。5.在男性患者的评分中,药物组和手术组在PF、 RP、GH、 MH4个方面评分无显著差异(P>0.05)；药物组的BP、 VT2个方面的评分均低于手术组,差异有统计学意义(P<0.05)；药物组的SF、 RE2个方面评分高于手术组,差异有统计学意义(P<0.05)结论1.SF-36量表在国内垂体泌乳素腺瘤的使用中有良好的信度和效度。2.泌乳素腺瘤患者总体上和常模相比,在生理健康方面低于常模,生理功能维度无显著差别；心理健康方面和常模相比存在差异,泌乳素腺瘤患者的社会功能和情感职能低于常模,但其精力和精神健康要优于常模。3.两种治疗方式相比,手术治疗比药物治疗更有利于减轻患者的生理痛苦,更有助于提高患者的精力和精神健康,但药物治疗患者的社会功能优于手术治疗,更有利于患者适应参与社会交往。4.女性微腺瘤患者手术治疗在生理健康和精神健康方面都优于药物治疗,手术治疗更有利于提高患者的生活质量。5.女性大腺瘤患者治疗方式对其生活质量影响无显著差别。6.男性患者手术治疗可减少其生理上的痛苦同时可比药物治疗更具精力,但药物治疗更有利于其社会功能和情感职能。更多还原

【Abstract】 Prolactinoma is the most common clinical of pituitary tumor subtypes, Mostly occurs in young adults, more common in women, majority of adenomas grow slowly, longer duration and mostly benign process, which seriously impact on the patients’ physical and mental health. Drugs and surgery can be effective treatment for prolactinomas, but these two treatments on the quality of life influence in patients with no studies.This study was designed to investigate and analyse the effect of the different treatment methods on quality of life of patients with prolactinomas. In order to provide constructive advice for clinical decision-making.Objective To measure the reliability and validity of the SF-36used among Chinese patients with prolactinomas, evaluate quality of life in patients with prolactinomas after treatment,comparison of the quality of life in patients with drug and surgical treatment and its influencing factors; Provide the basis for prolactinomas treatment options, and at the same time to provide guidance for health education of patients after treatment.Materials and Methods Subjects were patients with prolactinomas after treatment during April2011to April2012in Huashan Hospital, including drug treatment group55cases and surgical treatment group of50patients, a total of105cases. General questionnaire to collect patient demographic information and clinical data, the SF-36scale was used to investigate the quality of life of patients after treatment. Each patient were followed up for more than six months after treatment. Mainly through out-patient review, patients fill out the questionnaire on their own, combined with telephone follow-up, email, postal questionnaire and other methods of data acquisition. all patients themselves were asked to answer. The data were calculated by SPSS16.0. Scale reliability using Cronbach’s a to detect.Construct validity using factor analysis. Two sets of patient demographic and medical data were compared by by t-test or x2-test. The quality of life of our patients and domestic norm were compared using paired samples t-test, the two sample t-test was used to compare two groups of QOL.Results1. The Cronbach’s alpha coefficient of SF-36is0.864. The principal components analysis with varimax rotated solution was used to measure the construct validity, there are nine factors extracted which can explain69.25%variance totally, the test proved the validity of better.2. The scores of PF had no statistical difference between patients with prolactinomas and the domestic norm. The scores of RP、BP、 GH、 SF、 RE in the SF-36were lower than the domestic norm with statistical difference, but the scores of VT and MH were higher than the domestic norm.3. There was no significant difference between drug treatment group and surgical treatment group about the scores of PF, RP, GH, RE. The scores of BP, VT, MH in the drug treatment group were lower than in the surgical treatment group, difference have statistical significance; the scores of SF was higher than the surgical treatment group.4. The scores of PF,RP,GH,VT,SF had no statistical difference between drug treatment group and surgical treatment group in the female patients with micro-prolactinomas, and the scores of BP,RE,MH in the drug treatment group were higher than in the surgical treatment group. All dimensions have no significant difference on that of the female patients with macro-prolactinomas5. Within male patients, there was no significant difference in the scores of PF,RP,GH,MH between drug treatment group and surgical treatment group. The scores of BP, VT in the drug treatment group were lower than in the surgical treatment group with statistical difference, but the scores of SF and RE were higher in the drug treatment group.Conclusion l.The SF-36scale has good reliability and validity used in patients with prolactinomas in China.2. The overall physical health of patients with prolactinomas is lower than the norm, but no significant difference in the physiological functions. the Social Function and the Role-Emotional of patients with prolactinomas below the norm, but the Vitality and the Mental health are superior to norm.3. Surgical treatment is more conducive to relieve the patient’s Bodily Pain than drug treatment, but also help to improve the Vitality and Mental Health of patients, but drug therapy for the Social Function of patients better than operation therapy, is more advantageous to the patient involved in social communication.4. The surgical treatment of female patients with micro-prolactinomas in terms of physical health and mental health are better than drug treatment, surgical treatment is more conducive to improving the quality of life of patients.5. Treatment affect no significant difference in the quality of life of female patients with macro-prolactinomas.6. Male patients with surgical treatment can reduce the physical pain, and more energetic than drug treatment, but the drug treatment is more conducive to its social function and emotional functions.更多还原