中国临床医师对子宫肌瘤药物治疗的认识及其潜在分类研究  

Chinese clinicians' understanding on medical treatment of uterine myoma and latent cluster analysis

作　　者：朱昊平[1] 张焕玲[1] 沈洁[1] 陆梅[1] 陆珍[1] 陈科[1] 车焱[1] 

机构地区：[1]复旦大学生殖与发育研究院上海市计划生育科学研究所国家人口计生委计划生育药具重点实验室,上海200032

出　　处：《中国妇幼健康研究》2016年第9期1047-1049,1055,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的了解我国临床医师对子宫肌瘤药物治疗的认知、需求、选择依据及其对药物治疗子宫肌瘤的期望。方法在国内7个经济发达地区的2级和3级公立医疗机构对妇产科临床医师进行问卷调查,应用多水平Logistic回归模型及潜在类别分析对数据进行深入探讨。结果共在7个省市的57家医院对314名临床医师进行了问卷调查,半数以上受访者拥有硕士或博士学历,职称以主治和副主任为主。受访者均曾使用药物治疗子宫肌瘤,以孕激素受体调节剂（67.52%）和促性腺激素释放素类似物（66.88%）最为常用。选择药物治疗时受访医师对患者年龄（64.01%）、肌瘤大小（59.24%）、患者的意愿（57.32%）、生育功能保留（51.91%）和经济承受力（50.64%）考虑较多。多水平Logistic回归模型分析提示,受访医师药物治疗子宫肌瘤的决定在同一家医院有相似性。经潜在类别分析表明,受访医师子宫肌瘤药物治疗的思维模式可以分为＂药物治疗关键因素考量型＂（45.86%）、＂药物治疗排斥型＂（34.06%）以及＂药物治疗谨慎型＂（20.06%）三种,且硕士及以上学历的医师以第一种类型为主,本科学历者以第三种为主,上述模式与医师的职称无显著相关性（χ~2=8.000,P=0.237）。结论我国经济发达地区临床医师使用药物治疗子宫肌瘤的比例广泛,但所在医院以及临床医师教育程度对选择药物治疗的决策影响较大。Objective To analyze the understanding,needs,choice-making reasons and expectation on medical treatment of uterine myoma by clinicians in China. Methods Gynecologists from public medical institutions of grade II and grade III in 7 provinces in developed areas of China were enrolled to complete the survey. Logistic regression model and Latent cluster analysis were applied for further exploration. Results Totally 314 gynecologists from 57 hospitals in 7 provinces completed the survey. More than half of the clinicians obtained post-graduate or doctoral degree with attending or assistant director of technique ranks. All the clinicians had medical treatment experience of myoma,with progesterone receptor modulators（ PRMs）（ 67. 52%） and gonadotropin-releasing hormone agonist（ GnRha）（ 66. 88%） as the majority. Patient＇s age（ 64. 01%）,myoma size（ 59. 24%）,patient＇s will（ 57. 32%）,fertility reserve（ 51. 91%）and medical cost（ 50. 64%） were of primary concern. Multi-level Logistic regression indicated similarity in decision-making by clinicians from the same hospital. Latent cluster analysis revealed that the clinicians had ＂key-point consideration（ 45. 86%） ＂,＂medical treatment dislike（ 34. 06%） ＂ and ＂medical treatment caution（ 20. 06%） ＂ as their thinking patterns. Most clinicians of the ＂key-point consideration＂ obtained post-graduate or doctoral degree,while those with undergraduate degree were inclined to ＂medical treatment caution＂. Technical ranks had no significant relationship with the above latent classification. Conclusion Medical treatment of uterine myoma is widely practiced in developed areas of China,but its decision making is greatly influenced by clinician＇s working hospital and educational background.

关 键 词：临床医师 子宫肌瘤 药物治疗 多水平模型 潜在类别分析 

分 类 号：R711.7[医药卫生—妇产科学]