[中国医生对痛风的决策及其影响因素]

Fang Wei-gang, Zeng Xue-jun, Li Meng-tao, Chen Lan X, Schumacher H Ralph, Zhang Feng-chun

Department of General Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.

Zhonghua Yi Xue Za Zhi. 2006 Jul 18;86(27):1901-5.

OBJECTIVE

To investigate the decision-making about gout by physicians of China and influencing factors thereof.

METHODS

A questionnaire survey, including 13 multiple choice questions, was divided into 2 stages. The first/stage questionnaire survey was conducted among 121 physicians of the departments of internal medicine and rheumatology respectively during the grand ward rounds, and the second-stage questionnaire survey was conducted among 75 physicians attending a national continuous medical education (CME) workshop of rheumatology. The data thus collected were pooled and analyzed by logistic regression models.

RESULTS

62 effective questionnaires were collected in the first/stage survey, and 38 effective questionnaires were collected in the second-stage survey, both with a missing rate < 10%. 78.3% of the respondents considered aspiration of the joint fluid as critical for the definitive diagnosis of gout, but only 2.4% of the respondents did so frequently. When treating acute gout in otherwise healthy patients, 69.2% of the respondents preferred oral colchicine, and while treating the patients with renal dysfunction, 41.7% of the respondents used corticosteroids or corticotrophin as the first choice. For long-term uric acid-lowering therapy, 99 of them (82.5%) described a variety of incorrect indications, 107 of them (89.2%) initiated the treatment too early (< or = 2 weeks after the remission), and 92 of them (76.7%) failed to sustain the treatment for at least 5 years. Only 17 physicians (14.2%) used prophylaxis while initiating the uric acid-lowering treatment and only 7 of them (5.8%) selected a prophylaxis time of 7 approximately 12 months. Multiple logistic regression analysis showed that only CMD on gout was associated with correct diagnosis strategy (OR 7.1, 95% CI 2.1 approximately 23.7).

CONCLUSION

The management of gout by the physicians in China is often not consistent with that generally accepted internationally. High quality CME may improve the decision-making ability of physicians.

目的

调查中国医生对痛风的决策及其影响因素。

方法

一项包含13个多项选择题的问卷调查分为两个阶段。第一阶段问卷调查分别在大查房期间对121名内科和风湿科医生进行，第二阶段问卷调查在参加全国风湿科继续医学教育（CME）研讨会的75名医生中进行。收集到的数据汇总后用逻辑回归模型进行分析。

结果

第一阶段调查收集到62份有效问卷，第二阶段调查收集到38份有效问卷，两者缺失率均<10%。78.3%的受访者认为关节液抽吸对痛风的明确诊断至关重要，但只有2.4%的受访者经常这样做。在治疗健康状况良好的急性痛风患者时，69.2%的受访者首选口服秋水仙碱，而在治疗肾功能不全患者时，41.7%的受访者首选使用糖皮质激素或促肾上腺皮质激素。对于长期降尿酸治疗，其中99人（82.5%）描述了各种不正确的适应症，107人（89.2%）过早开始治疗（缓解后<或=2周），92人（76.7%）未能持续治疗至少5年。只有17名医生（14.2%）在开始降尿酸治疗时使用了预防措施，其中只有7人（5.8%）选择了7至12个月的预防时间。多因素逻辑回归分析显示，只有痛风的CMD与正确的诊断策略相关（OR 7.1，95%CI 2.1至23.7）。