我国泌尿外科与老年科医师对良性前列腺增生患者诊断与用药策略的比较

Comparison of the diagnosis and medication strategy for patient of benign prostatic hyperplasia between urologist and geriatrician in China

目的 比较泌尿外科与老年科医师对良性前列腺增生（BPH）患者诊断与用药策略的差异,推动我国BPH临床诊疗实践的规范化.方法 对我国各地城市综合医院的泌尿外科和老年科进行分层抽样,整群抽取了2010年12月至2011年12月特定日期在门诊就诊的BPH患者共145 315人进行调查,由接诊医师填写问卷.对患者一般特征、两科医师诊断和治疗BPH的方法进行对比.结果 共收集有效问卷142 511份,其中泌尿外科119 426份,老年科23 085份.患者年龄（68.34±8.61）岁,症状评分（17.93±4.73）分.诊断依据使用率由高到低依次为症状评分（99.2％）、超声检查（86.0％）、直肠指检（66.0％）和尿流率检查（55.2％）,其中泌尿外科的超声检查率低于老年科,其余项检查率均高于老年科,直肠指检率是后者的2.2倍,以上差异均有统计学意义（p＜0.01）.对于中、重度BPH患者,泌尿外科医师以联合用药为主（中度72.1％,重度79.9％）,其应用率为老年科的2倍（p＜0.01）;老年科医师以单独用药为主（中度59.7％,重度56.1％）.泌尿外科对α受体阻滞剂、植物制剂和中药的应用率高于老年科（P＜0.01）.结论 泌尿外科医师对BPH的初步诊断策略比老年科医师更为全面.对于中、重度BPH患者,老年科医师倾向于单独应用5α还原酶抑制剂,泌尿外科医师倾向于联合应用5α还原酶抑制剂＋α受体阻滞剂.

Objective To promote the standardization of medical practice in China by comparing the discrepancies of diagnosis and medication strategies for benign prostatic hyperplasia （BPH） between urologists and geriatricians.Methods Departments of urology and geriatrics in general hospitals in China were selected through stratified sampling and 145 315 patients who went for the outpatient service in certain days during December 2011 to December 2012 were recruited by cluster.Questionnaires were completed by corresponding doctors and data of patient clinical characteristics as well as diagnostic and therapeutic pattern were collected.Results A total of 142 511 valid questionnaires were collected with 119 426 from urology and 23 085 from geriatrics.The average age of BPH patients was （68.34±8.61） years and the average IPSS was 17.93±4.73.The rates of diagnostic method were IPSS （99.2％）,ultrasonic inspection （86.0％）,digital rectal examination （DRE） （66.0％） and urine flow rate test （55.2％）.The rate of ultrasonic application was lower while the rates of other methods were higher among urologists （P＜0.01） ; the rate of DRE among urologists was 2.2 times to that among geriatricians.For patients with moderate or severe symptoms,most urologists （72.1％ in moderate patients and 79.9％ in severe patients） applied drug-combination strategy and the rate was 2 times to that among geriatricians （P＜0.01）.In contrast,most geriatricians （59.7％ in moderate patients and 56.1％ in severe patients） applied single drug to BPH patients.Urologists utilized α-receptor blockers,plant preparations and traditional Chinese medicine more frequently than geriatricians （P＜0.01）.Conclusions Urologists performed more integrated diagnosis strategy compared with geriatricians.The urologists tended to use 5α-reductase inhibitor combined with α-receptor blocker to treat BPH patients with moderate or severe symptoms,while geriatricians preferred 5α-reductase inhibitor alone.