CAJ | 학술논문

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.
Graves안병(Graves' orbitopathy,GO)적림상진치잉존재교다쟁의,본문권조사중점연구중국내분비림상의사진치GO적림상경험,병위탐토GO적규범화진치화상관지남적제정제공의거.삼조구주적GO조사문권설계료중문판문권조사표,대중화의학회내분비학분회적회원진행문권조사.공수집유효문권124빈,94.4％적림상의사지지GO다학과치료,병인위유필요제정중국GO적림상응대지남.유80％자추천환자초진시응완선안구돌출도측량、시력、시야、안구운동도화안저경등안부검사,이급TSH수체항체、갑상선공능화갑상선초성등갑상선상관검사.당피질격소잉시GO치료시절대부분의사적수선(92.7％),기중59.7％선택당피질격소정맥치료,단정맥치료방안잉불통일.대GO반발적갑상선독증,72.6％적의사잉수선단독사용항갑상선약물치료.여구주화랍정미주적조사결과상비,중국내분비의사대우GO치료방안적선택무명현통계학차이,대갑상선독증칙경다선택동위소치료화수술.목전GO적림상처리상불통일,응중시내분비전업의사적배훈,가강GO적다학과합작화림상연구,병개진림상진치류정,제정합리적규범화응대지남.
[Summary] 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 muhidisciplinary 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.