Jansky Michael, Mattlinger Christina, Nguyen-Tat Marc, Galle Peter R, Lammert Frank, Jäger Johannes, Wangler Julian
Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz.
I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz.
Dtsch Med Wochenschr. 2018 Mar;143(6):e34-e41. doi: 10.1055/s-0043-122251. Epub 2018 Jan 9.
In general practitioner care, abnormal liver chemistries are often being diagnosed unintentionally. So far, there is no evidence-based, structured diagnostic pathway for classifying and evaluating elevated liver enzymes, especially with regard to the early detection of patients at increased risk for liver fibrosis or liver cirrhosis. Accordingly, dealing with elevated liver values which are noticed in the course of a general blood examination is a diagnostic challenge that strongly depends on the doctor's approach.
In the course of a survey, 391 general practitioners in Rhineland-Palatinate and Saarland were interviewed between March and June 2017. The focus was on behavior and strategies with regard to the clarification of elevated liver values as well as the identification of challenges and training interests. In addition to the descriptive analysis, a factor analysis was performed.
The determination of liver values such as γ-GT, AST and ALT is frequently performed in general practitioner care without the existence of any particular cause. There are strongly different clusters of liver values that are being analyzed in the course of a liver function test. In the case of increased liver values, a majority of the physicians surveyed generally prefer a controlled waiting (58 %). Due to the absence of an established diagnosis and treatment pathway, challenges arise in everyday practice which relate to controlled waiting, cooperation with gastroenterological specialists, as well as orientation to predefined laboratory value portfolios.
In addition to the introduction of an evidence-based diagnosis and treatment pathway, it should be considered to optimize the flow of information between general practitioners and gastroenterological specialists. Last but not least, it would be desirable if more training courses for general practitioners could be offered in this subject area.
在全科医疗中，肝脏生化指标异常常常是无意中被诊断出来的。到目前为止，尚无基于证据的结构化诊断途径用于对肝酶升高进行分类和评估，尤其是在早期发现肝纤维化或肝硬化风险增加的患者方面。因此，处理在常规血液检查过程中发现的肝脏指标升高是一项诊断挑战，这在很大程度上取决于医生的处理方式。
在一项调查过程中，2017年3月至6月期间对莱茵兰 - 普法尔茨州和萨尔州的391名全科医生进行了访谈。重点是关于澄清肝脏指标升高的行为和策略以及识别挑战和培训兴趣。除了描述性分析外，还进行了因子分析。
在全科医疗中，经常在没有任何特定原因的情况下测定γ - GT、AST和ALT等肝脏指标。在肝功能检查过程中分析的肝脏指标存在明显不同的类别。对于肝脏指标升高的情况，大多数接受调查的医生通常倾向于进行控制性观察（58%）。由于缺乏既定的诊断和治疗途径，日常实践中出现了与控制性观察、与胃肠病学专家合作以及遵循预定义实验室指标组合相关的挑战。
除了引入基于证据的诊断和治疗途径外，还应考虑优化全科医生和胃肠病学专家之间的信息流通。最后但同样重要的是，如果能在该主题领域为全科医生提供更多培训课程将是可取的。
