Graves眼病临床应对的中国医师问卷调查研究  

A questionnaire survey on the management of Graves′ orbitopathy in China

作　　者：徐书杭[1] 郑全喜[1] 杨昱[1] 胡咏新[1] 王昆[1] 刘超[1] 

机构地区：[1]中国中医科学院江苏学院、南京中医药大学附属中西医结合医院内分泌代谢病院区,南京210028

出　　处：《中华内分泌代谢杂志》2013年第10期900-903,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金资助项目（81200577）;江苏省科技计划项目（BM2012064）

摘　　要：Graves眼病（Graves′orbitopathy,GO）的临床诊治仍存在较多争议,本问卷调查重点研究中国内分泌临床医师诊治GO的临床经验,并为探讨GO的规范化诊治和相关指南的制定提供依据。参照欧洲的GO调查问卷设计了中文版问卷调查表,对中华医学会内分泌学分会的会员进行问卷调查。共收集有效问卷124份,94.4％的临床医师支持GO多学科治疗,并认为有必要制定中国GO的临床应对指南。逾80％者推荐患者初诊时应完善眼球突出度测量、视力、视野、眼球运动度和眼底镜等眼部检查,以及TSH受体抗体、甲状腺功能和甲状腺超声等甲状腺相关检查。糖皮质激素仍是GO治疗时绝大部分医师的首选（92.7％）,其中59.7％选择糖皮质激素静脉治疗,但静脉治疗方案仍不统一。对GO伴发的甲状腺毒症,72.6％的医师仍首选单独使用抗甲状腺药物治疗。与欧洲和拉丁美洲的调查结果相比,中国内分泌医师对于GO治疗方案的选择无明显统计学差异,对甲状腺毒症则更多选择同位素治疗和手术。目前GO的临床处理尚不统一,应重视内分泌专业医师的培训,加强GO的多学科合作和临床研究,并改进临床诊治流程,制定合理的规范化应对指南。To determine how endocrinologists in China access and treat patients with Graves′ orbitopathy（GO）and gain insight on how to make the management of this disease more uniform and standardized in the context that management of GO continues to be challenging. Based on the questionnaire used in the European survey on GO, a questionnaire in Chinese was drafted and circulated to the members of Chinese Society of Endocrinology（CSE）. There were a total of 124 valid responders. The majority（94.4%）of the responders believe that a multidisciplinary approaches for GO management is valuable. Over 80% of the participants advocated the evaluation of exophthalmometry, vision, visual fields by perimetry, eye movements, fundoscopy, TSH receptor antibodies, thyroid function, and ultrasound. Steroids were preferred as the first-line therapy by 92.7% of responders, among them, 59.7% choose intravenous route. The treatment strategy for GO with intravenous glucocorticoids therapy still remains debated. Antithyroid drugs were the most common choice（72.6%）for first-line therapy of thyrotoxicosis. Treatment options for GO were very similar among Chinese, Latin-American, and European responders, though radioactive iodine and surgical treatment were more often indicated in China. The appropriate treatment of the patient with GO is controversial even amongst thyroid specialists. Further training of clinicians, easier access of patients to specialist multidisciplinary centres, and the publication of practice guidelines may help improving the management of this condition in China.

关 键 词：格雷夫斯眼病 甲状腺毒症 问卷调查 

分 类 号：R581.1[医药卫生—内分泌]