摘要
目的了解江苏省Graves病诊疗现状。方法参考2011年美国甲状腺学会和2013年欧洲甲状腺学会的Graves病问卷调查表设计问卷,对江苏省12市共35家三级医院的内分泌科医师进行问卷调查,内容主要包括Graves病的诊断、治疗和随访。结果共回收有效问卷476份。对于有甲亢症状的患者,内分泌科医生多会选择FT3、FT4、TSH、甲状腺过氧化物酶抗体、甲状腺球蛋白抗体、促甲状腺激素受体抗体、甲状腺超声等检查,所占比例分别为95.6%、95.0%、95.4%、95.8%、90.3%、90.5%及93.9%。在治疗方式选择上,有91.2%的医生首选抗甲状腺药物,92.6%的医生优先考虑使用甲巯咪唑;在药物治疗总时间上,41.2%的医生会选择24个月的治疗周期,选择18个月的占20%。当患者出现中度活动性眼病时,大多数中、高级职称的内分泌科医生首选抗甲状腺药物治疗,而初级职称医生多选择放射性碘联合糖皮质激素治疗。当Graves病患者确定妊娠时,88%的医生建议妊娠初期使用丙硫氧嘧啶,妊娠中期仍有58.4%的医生继续给予丙硫氧嘧啶治疗。结论医师对Graves病诊疗基础认知较好,但是与欧美及指南上有部分差异。因此,内分泌科医生应注意这些差异,以达到Graves病的标准化治疗,提高治疗效果及降低复发率。
Objective To investigate the management of Graves' disease in Jiangsu province. Methods According to the 2011 management of GD survey from American Thyroid Association and the 2013 survey from European Thyroid Association, a questionnaire was designed for this survey to acquire the diagnosis, treatment, and follow-up of Graves' disease among endocrinologists from 35 tertiary hospitals in Jiangsu province. Results A total of 476 valid questionnaires were collected. For patients with symptoms of hyperthyroidism, a large majority of respondents monitored serum FT3, FT4, TSH, thyroid peroxidase antibody, thyroglobulin antibody, TSH receptor antibody, and finding of thyroid ultrasound, accounted for 95.6%, 95.0%, 95.4%, 95.8%, 90.3%, 90.5%, and 93.9% physicians, respectively. 91.2% of physicians preferred anti-thyroid drugs as the first-line treatment, and 92.6% of them gave priority to the use of methimazole. For the duration of anti-thyroid drugs therapy, 41.2% of endocrinologists chose 24 months, while 20% chose 18 months. When patients have moderate and active ophthalmopathy, most respondents with medium or senior professional titles preferred anti-thyroid drugs, while most resident physicians chose radioactive iodine plus corticosteroids. When pregnancy was confirmed in the patients of Graves′ disease, 88% of respondents preferred propylthiouracil during the first trimester of pregnancy, and 58.4% of them would continue propylthiouracil into the second trimester. Conclusion The mastering of basic perception of Graves' disease knowledge is satisfactory among the endocrinologists. But by comparing to the American and European survey results and related guidelines, there are still some differences in diagnosis and treatment. Therefore, physicians should notice those differences and make improvement on standardized treatment for patients to raise the response ratio while reducing the recurrent events.
作者
李田田
邹小白
范红旗
孙敏
顾愹
王坚
朱大龙
马建华
李伟
崔世维
成兴波
杨涛
郑旭琴
Li Tiantian;Zou Xiaobai;Fan Hongqi;Sun Min;Gu Yong;Wang Jian;Zhu Dalong;Ma Jianhua;Li Wei;Cui Shiwei;Cheng Xingbo;Yang Tao;Zheng Xuqin(Department of Endocrinology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Endocrinology,Nanjing General Hospial of Nanjing Military Command,Nanjing 210002,China;Department of Endocrinology,Nanjing Drum Tower Hospital,Nanjing 210008,China;Department of Endocrinology,Nanjing First Hospital,Nanjing 210006,China;Department of Endocrinology,the Affiliated Hospital of Xuzhou Medical College,Xuzhou 221006,China;Department of Endocrinology,Affiliated Hospital of Nantong University,Nantong 226001,China;Department of Endocrinology,the Firsty Affiliated Hospital of Soochow University,Suzhou 215006,China)
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2019年第7期576-580,共5页
Chinese Journal of Endocrinology and Metabolism
基金
国家自然科学基金项目(81770777).
