诊断学理论与实践 ›› 2024, Vol. 23 ›› Issue (04): 347-353.doi: 10.16150/j.1671-2870.2024.04.001
收稿日期:
2024-05-08
接受日期:
2024-08-02
出版日期:
2024-08-25
发布日期:
2024-08-25
通讯作者:
单忠艳 E-mail: cmushanzhongyan@163.comReceived:
2024-05-08
Accepted:
2024-08-02
Published:
2024-08-25
Online:
2024-08-25
摘要:
我国甲状腺功能亢进(甲亢)临床患病率为0.78%,亚临床甲亢患病率为0.44%,格雷夫斯病(Graves diseased)甲亢患病率为0.53%。未经治疗的甲亢和亚临床甲亢可导致心房颤动、卒中及其他心血管事件、骨质疏松症和骨折的发生风险增加。在一些特殊人群(如妊娠妇女、老年人群)中,不仅甲亢的诊断有其特殊性,治疗适应证及方法选择也有所不同。我国目前甲亢规范诊治已经取得一定进展,但存在如下问题。甲亢指南在甲亢的诊断方面已制定了诊断和鉴别诊断的流程,但在临床实践中还存在一定的困难,主要在于有些医院甲状腺核素显像和131碘摄取率缺乏普遍可及性。其次,利用甲状腺超声获得的甲状腺内收缩期峰值流速(peak systolic velocity, PSV)进相关诊断,目前在我国尚未普遍推广。我国临床治疗甲亢的主要方法已与国际接轨,但初治期ATD治疗的具体起始剂量和减量期剂量的调整仍缺乏我国自己的依据和非常明晰的标准,目前大多数临床医师还是遵循美国甲状腺学会制定的指南推荐的剂量起始方案。此外,国内外缺乏预测ATD不良反应的指标,在ATD治疗甲亢的过程中,一过性粒细胞减少的发生率为1%~5%,需基线随访及监测血常规和肝功能。目前,国内外指南关于监测频率仍缺乏明确的规定,且缺乏高质量的循证医学证据支持,而临床也尚未确立可行的ATD不良反应预测指标。ATD导致粒细胞缺乏症被认为可能与基因易感性、年龄、药物种类及剂量有关,中国汉族人中6号染色体上的HLA-B*27:05、HLA-B*38:02和HLA-DRB1*08:03可能是易感基因。我国在甲状腺相关眼病(thyroid associated ophthalmopathy,TAO)的诊治方面有极大提高,36.7%的中国医生对TAO患者会采用多学科协作模式。受到生物制剂可及性的影响,但我国采用生物制剂进行TAO治疗者不足10%,明显低于西方国家。针对我国甲亢诊治目前的现状和挑战,还需采取进一步提高疾病的诊治水平。
中图分类号:
李静, 单忠艳. 我国甲状腺功能亢进的诊治现状及挑战[J]. 诊断学理论与实践, 2024, 23(04): 347-353.
LI Jing, SHAN Zhongyan. Current status and challenges of diagnosis and treatment of hyperthyroidism in China[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(04): 347-353.
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