Ponto Katharina A, V D Osten-Sacken Sara, Elflein Heike, Koutsimpelas Dimitrios, Pfeiffer Norbert, Kahaly George J
Augenklinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55101, Mainz, Deutschland.
I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Deutschland.
Ophthalmologe. 2020 Nov;117(11):1105-1111. doi: 10.1007/s00347-020-01050-4.
Endocrine orbitopathy (EO) encompasses functional and cosmetic limitations. The aim of this study was to assess the health services situation of patients with EO treated at a multidisciplinary specialized center.
The medical records pertaining to the clinical spectrum, access route, and medical specialty of the referring physician of patients who were treated within a period of 5 years at a tertiary referral orbit center were systematically assessed.
A total of 431 subjects with EO (female n =354, 82%; median age 40 years, range 5-79 years) were included in the study. Of the patients 148 (35%) and 123 (29%) were referred by family physicians and ophthalmologists, respectively. A sight-threatening optic nerve neuropathy was present in 11 (14.3%) men and 21 (5.9%) women (p =0.011). At least 2 other autoimmune diseases were found in 8 (10.4%) men and in 15 (4.3%) women (p =0.079). Psychotherapeutic support was utilized by 2 (2.6%) men and 92 (26%) women (p <0.001). An access route of 50 km or more was accepted by 14 (28%) men and 83 (43%) women (p =0.054). There was also an association between an access route ≥100 km and a prior medical treatment (odds ratio 3.78, 95% confidence interval 1.18-12.05, p =0.025).
Men were more severely affected by EO than women and often had complex autoimmune diseases; however, male patients were less frequently willing to accept long access routes and barely used psychosocial support. Especially patients with further autoimmune diseases travelled long distances to be treated at a specialized center.
内分泌性眼眶病(EO)会导致功能和外观方面的限制。本研究旨在评估在多学科专业中心接受治疗的EO患者的医疗服务情况。
系统评估了在一家三级转诊眼眶中心接受治疗的患者在5年内的病历,内容包括临床症状、转诊途径以及转诊医生的医学专业。
本研究共纳入431例EO患者(女性354例,占82%;年龄中位数40岁,范围5 - 79岁)。其中,分别有148例(35%)和123例(29%)患者由家庭医生和眼科医生转诊。11例(14.3%)男性和21例(5.9%)女性存在威胁视力的视神经病变(p = 0.011)。8例(10.4%)男性和15例(4.3%)女性至少还患有另外2种自身免疫性疾病(p = 0.079)。2例(2.6%)男性和92例(26%)女性接受了心理治疗支持(p < 0.001)。14例(28%)男性和83例(43%)女性接受了50公里或更长距离的转诊途径(p = 0.054)。转诊途径≥100公里与先前的治疗之间也存在关联(优势比3.78,95%置信区间1.18 - 12.05,p = 0.025)。
男性比女性受EO影响更严重,且常患有复杂的自身免疫性疾病;然而,男性患者较少愿意接受长距离的转诊途径,且很少使用社会心理支持。尤其是患有其他自身免疫性疾病的患者会长途跋涉到专业中心接受治疗。