بررسي عوامل مرتبط با رخداد هيپوگناديسم در بيماري تالاسمي ماژور با استفاده از مدل تحليل بقاء

The assessment of hypogonadism occurence and related factors among beta thalassemia major patients using survival analysis model

Background and Aim: Hypogonadism is the most common endocrinologic complication among major beta thalassemia patients. Absence or irregular chelation therapy in these patients leads to various complications such as hypogonadism. This complication in addition to organic dysfunction, results in behavioral and psychological effects on the patients and their families. Hie purpose of this study was to evaluate the prevalence and determination of effective factors on occurrence and cumulative risk of this complication. Materials and Methods: 641 thalassemic (316 males and 325 females) patients referring to Cooleyʹs ward of Dastgheib hospital in Shiraz were studied using a structured questionnaire through enumeration method in 2005-2006. The age of occurrence, demographic information, the age of onset and type of transfusion, and the age of onset and method of chelation therapy were specified. Specialist physicians diagnosed the complication. The data were analyzed using descriptive and analytical (OR confidence interval, chi square test, student T- test and Log Rank test) statistics. Results: Mean ± SD of age in these patients were 17.32 ±5.3 years. The prevalence of hypogonadism was 18.3%. This complication was seen in 24.9% of girls and 11.4% of boys. Risk of this complication in girls was 2.6 times more than boys (p<0.05), and in patients that their mothers had not academic education this ratio was 2.2 times as compared to patients that their mothers had academic education (p<0.05). The age of onset of this complication in girls and boys was 17.13 ± 7.08 and 19.31 ± 2.57 years respectively (p>0.05). There was no significant association between prevalence of hypogonadism and type of transfused blood and chelating method. In survival analysis model using Log Rank test, age at onset of chelating and sex were related with cumulative risk of this complication (p<0.05). The median of survival without hypogonadism was 26.5 years. Conclusions: Early onset of blood transfusion with late onset of chelating increases the occurrence probability and early onset of this complication. For prevention of this complication, we recommended that onset of blood transfusion must be according to onset of chelating. Educational level of parents and education to parents and patients is very important. Progression of this complication will be prevented by regular survey and early diagnosis and this complication leads to high ability of the patients.