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背景关于亚临床甲状腺功能减退治疗效果的证据十分有限,特别是对于老年患者的治疗效果。目的探讨全科医生在不同国家和针对不同类型的患者对老年亚临床甲状腺功能减退治疗的不同方式。设计和环境在荷兰、德国、英格兰、爱尔兰、瑞士和新西兰进行基于案例的全科医生调查。方法评估全科医生对于8例表现为亚临床甲状腺功能减退患者的治疗策略(治疗是/否,起始剂量甲状腺素)。患者的特征如年龄(70岁与85岁),活力状态(充满活力与脆弱)和促甲状腺激素(TSH)浓度(6 m U/L与15 m U/L)均有差异。结果共有526名全科医生参与此项研究(瑞士262名、荷兰129名、德国61名、新西兰31名、英格兰22名、爱尔兰21名,总有效率为19%)。不同国家的治疗策略会有所不同。相比较于来自德国(平均治疗比例为73%)、爱尔兰(平均治疗比例为62%)和瑞士(平均治疗比例为52%)的全科医生,来自荷兰(平均治疗比例为34%)、英格兰(平均治疗比例为40%)和新西兰(平均治疗比例为39%)的全科医生更加不倾向于实施治疗(P=0.05)。总体来讲,全科医生更倾向于对70岁的女性患者实施治疗,而不是85岁的女性患者〔比值比=0.74,95%CI(0.63,0.87)〕。TSH为15 m U/L的患者比TSH为6m U/L的患者更易于得到治疗〔比值比=9.49,95%CI(5.81,15.5)〕。结论全科医生对于不同国家和不同类型的老年亚临床甲状腺功能减退患者的治疗策略有很大差异,而这种差异说明有必要建立新一代基于初级卫生医疗随机临床试验的国际指南。
Background There is very limited evidence for the efficacy of subclinical hypothyroidism, especially in elderly patients. Objectives To explore different ways for general practitioners to treat subclinical hypothyroidism in the elderly in different countries and for different types of patients. Design and Environment A case-based general practitioner survey was conducted in the Netherlands, Germany, England, Ireland, Switzerland and New Zealand. Methods The GPs were evaluated for treatment strategy in eight patients with sub-clinical hypothyroidism (treatment yes / no, initial dose of thyroxine). Patient characteristics such as age (70 and 85 years), vitality (full of vitality and vulnerability), and thyroid stimulating hormone (TSH) concentrations (6 mU / L and 15 mU / L) were different. Results A total of 526 general practitioners participated in the study (262 in Switzerland, 129 in the Netherlands, 61 in Germany, 31 in New Zealand, 22 in England and 21 in Ireland with a total effective rate of 19%). The treatment strategies vary from country to country. Compared to the general practitioners from Germany (average cure rate 73%), Ireland (62% average treatment rate) and Switzerland (average treatment rate 52%), from the Netherlands (34% average treatment), England (40% on average) and New Zealand (39% on average) were less likely to be treated (P = .05). In general, GPs are more likely to treat 70-year-old women than women who are 85 years old (odds ratio = 0.74, 95% CI, 0.63, 0.87). Patients with a TSH of 15 mU / L were more likely to be treated than patients with a TSH of 6 mU / L (odds ratio = 9.49, 95% CI (5.81, 15.5)]. CONCLUSIONS GPs vary widely in the treatment strategies for subclinical hypothyroidism in older people of different countries and types, and this discrepancy illustrates the need to establish a new generation of international guidelines based on randomized clinical trials of primary health care.