摘要
目的在2008年北京风湿病年会问卷调查的基础上了解目前我国风湿科临床医生对系统性硬化症(SSc)的诊治现状,进一步规范国内临床诊治及为开展前瞻性临床研究选择思路和方向。方法 2008年北京风湿病年会期间以问卷形式对参会医师进行调查。内容涉及医师的工作经验,诊断方法及治疗方法的选择,对预后的判断。同时比较有经验的医师(诊治例数>10例/年)以及少经验的医师(诊治例数≤10例/年)诊治选择的差异。结果共回收有效问卷250份,大多数为风湿科专科医师(78.4%)。少经验的医师共126名,有经验医师122名。大多数医师(84.3%)知晓甲褶微循环,认为甲褶微循环能够反映SSc患者周围循环(82%)及对患者的诊治和预后评估有帮助(81.2%),但只有19.5%的医师所在医院能够进行该项检查。有经验的医师对甲褶微循环的认识以及实际应用的比例显著高于少经验的医师。对于单纯皮肤受累的SSc患者,有经验的医师更倾向于选择青霉胺(58.8%)。绝大多数医师认为对于出现肺间质病变(80.5%)以及肺动脉高压(69.5%)的SSc患者需同时应用激素和免疫抑制剂治疗。只有32.2%的医师诊治过肾危象的患者;51.4%的医师认为肾危象时应使用血管紧张素Ⅱ受体拮抗剂(ARB)/血管紧张素转化酶抑制剂(ACEI)类药物,而少经验的医师中只有36.7%选择应用ACEI类药物,显著少于有经验的医师(63.3%)。对雷诺现象的治疗,钙离子拮抗剂类、内皮素受体抑制剂以及前列腺素的选择方面,有经验的医师(84.2%、45.0%、60.8%)明显高于少经验的医师(72.9%、33.1%、44.9%),其中对钙通道阻滞剂(CCB)类药物及前列腺素的选择两者之间有显著差异。结论 SSc对风湿科医师而言仍为非常见疾病。虽然作为已开展很久的检查方法,甲褶微循环并未在风湿科临床医师中得到广泛的认识和应用。尽管医师对单纯皮肤受累的治疗选择不一,但对�
Objective To investigate the current situation of the diagnosis and treatment of systemic sclerosis （SSc） in China. Methods The questionnaires were sent to participants of Beijing Rheumatology Association 2008 annual meeting. The survey included the doctor＇ s experience, method of diagnosis, treatment chosen and outcome prediction. The difference in diagnosis and treatment between the experienced doctors （who had diagnosed SSc for more than 10 patients per year） and less experienced doctors（who had diagnosed SSc for less than 10 patients per year） were compared. Results 250 questionnaires were returned. Most doctors were rheumatologists（78.4% ）. 126 were less experienced doctors and 122 were experienced ones. Most doctors （84. 3% ） knew nailfold videocapillaroscopy（NVC） and 82% doctors thought it could reflect the microcirculation of SSc patients. 81.2% of doctors thought that it was helpful for diagnosis and evaluating the outcome but the videocapillaroscope were available in only 19.5% hospitals. Penicillamine was selected for SSc patient with no organ involvement by most experienced doctors （58. 8 % ）. Most doctors thought both glucocorticoid and immunodepressant should be prescribed to patients with pulmonary interstitial fibrosis （PIF） and/or pulmonary artery hypertension（PAH）. Renal crisis is unusual and most doctors （51.4%）, especially experienced doctors, thought angiotensin receptor blocker（ ARB）/angiotensin-converting-enzyme inhibitor （ACEI） should be taken for renal crisis. There was significant difference between experienced doctors and less experienced doctors in the treatment of Raynaud＇ s phenomenon： calcium channel blocker （45% vs. 33.1% ） and prostaglandin （60. 8% vs. 44.9% ）. Conclusions SSc is a less common disease for rheumatologists. There is no widespread recognition and application of NVC. The management for skin involvement only is diverse, but most doctors think combined treatment should be taken for PIF and/or PAH. Further stu
出处
《中华临床免疫和变态反应杂志》
2012年第1期38-42,共5页
Chinese Journal of Allergy & Clinical Immunology
基金
欧洲抗风湿病联盟硬皮病试验研究组
首都医学发展科研基金重点支持项目(2009-2003)
中华医学会临床医学科研专项资金项目(08010270105)
北京协和医院青年科研基金(I604900)~~
