摘要
我国甲状腺功能亢进(甲亢)临床患病率为0.78%,亚临床甲亢患病率为0.44%,格雷夫斯病(Graves diseased)甲亢患病率为0.53%。未经治疗的甲亢和亚临床甲亢可导致心房颤动、卒中及其他心血管事件、骨质疏松症和骨折的发生风险增加。在一些特殊人群(如妊娠妇女、老年人群)中,不仅甲亢的诊断有其特殊性,治疗适应证及方法选择也有所不同。我国目前甲亢规范诊治已经取得一定进展,但存在如下问题。甲亢指南在甲亢的诊断方面已制定了诊断和鉴别诊断的流程,但在临床实践中还存在一定的困难,主要在于有些医院甲状腺核素显像和131碘摄取率缺乏普遍可及性。其次,利用甲状腺超声获得的甲状腺内收缩期峰值流速(peak systolic velocity,PSV)进相关诊断,目前在我国尚未普遍推广。我国临床治疗甲亢的主要方法已与国际接轨,但初治期ATD治疗的具体起始剂量和减量期剂量的调整仍缺乏我国自己的依据和非常明晰的标准,目前大多数临床医师还是遵循美国甲状腺学会制定的指南推荐的剂量起始方案。此外,国内外缺乏预测ATD不良反应的指标,在ATD治疗甲亢的过程中,一过性粒细胞减少的发生率为1%~5%,需基线随访及监测血常规和肝功能。目前,国内外指南关于监测频率仍缺乏明确的规定,且缺乏高质量的循证医学证据支持,而临床也尚未确立可行的ATD不良反应预测指标。ATD导致粒细胞缺乏症被认为可能与基因易感性、年龄、药物种类及剂量有关,中国汉族人中6号染色体上的HLA-B*27:05、HLA-B*38:02和HLA-DRB1*08:03可能是易感基因。我国在甲状腺相关眼病(thyroid associated ophthal-mopathy,TAO)的诊治方面有极大提高,36.7%的中国医生对TAO患者会采用多学科协作模式。受到生物制剂可及性的影响,但我国采用生物制剂进行TAO治疗者不足10%,明显低于西方国家。针对我国甲亢诊治目前的现状和挑战,还需采取进一步提高疾病的诊治水平。
In China,the clinical prevalence of hyperthyroidism is 0.78%,subclinical hyperthyroidism is 0.44%,and Graves′disease hyperthyroidism is 0.53%.Untreated hyperthyroidism and subclinical hyperthyroidism may increase the risk of atrial fibrillation,stroke,and other cardiovascular events,as well as osteoporosis and fractures.In special popula⁃tions(such as pregnant women and the elderly),both the diagnosis and treatment of hyperthyroidism require special conside⁃rations.Although China has made some progress in the standardized diagnosis and treatment of hyperthyroidism,chal⁃lenges remain.Despite established guidelines for diagnosis and differential diagnosis,clinical practice faces obstacles,nota⁃bly due to limited access to thyroid radionuclide imaging and 131 iodine uptake rate in some hospitals.Additionally,the peak systolic velocity(PSV)in the thyroid obtained by thyroid ultrasound is not widely adopted.While clinical treatment methods align with international standards in China,there is a lack of specific guidelines on the initial dose and dose adjust⁃ment during the reduction period of antithyroid drugs(ATD).Currently,most clinicians follow the initial dose regimen re⁃commended by the guidelines established by the American Thyroid Association.Furthermore,indicators in both domestic and international guidelines for predicting adverse reactions to ATD remain unclear.During the ATD treatment of hyperthy⁃roidism,the incidence of transient neutropenia is 1%-5%,and follow⁃up of baseline blood routine and liver function is ne⁃cessary.At present,there is a lack of monitoring frequency regulations and high⁃quality evidence⁃based medical support for above indice,and clinical practice has not yet established feasible indicators for predicting ATD adverse reactions.ATD⁃in⁃duced agranulocytosis is related to genetic susceptibility,age,drug type and dosage.HLA⁃B*27:05,HLA⁃B*38:02 and HLA⁃DRB1*08:03 on chromosome 6 in Chinese Han population may be susceptibility genes.Progress has been made in the diagnosis and treatment of thyroid associated ophthalmopathy(TAO)in China,with 36.7%of doctors adopting a multi⁃disciplinary approach.Due to accessibility issues,less than 10%of patients receive biological agents to treat TAO,which is significantly lower than that in Western countries.Given these current status and challenges in China,further measures are necessary to improve the diagnosis and treatment of hyperthyroidism.
作者
李静
单忠艳
LI Jing;SHAN Zhongyan(Department of Endocrinology and Metabolism,The Institute of Endocrinology,NHC Key Laboratory of Diagnosis and Treat-ment of Thyroid Disease,The First Hospital of China Medical University,Shenyang 110001,China.)
出处
《诊断学理论与实践》
2024年第4期347-353,共7页
Journal of Diagnostics Concepts & Practice
