医生经验对多囊卵巢综合征诊治影响的调查分析

Investigation on the Influence of Physician Experience on the Diagnosis and Treatment of Polycystic Ovary Syndrome

目的:调查不同经验妇产科医生对多囊卵巢综合征(PCOS)认识和诊疗的差异,旨在促进交流,提高医疗质量。方法:采用多中心横断面调查。线上收集参与者的基本情况和对于PCOS合并症认识和治疗处理等信息,根据医生经验分为经验丰富(接诊量>200人次/年)和经验欠丰富(接诊量≤200人次/年)两组,对比不同经验医生对PCOS诊断和治疗方面的差异,并采用Logistic回归分析其他可能对PCOS诊治产生影响的因素。结果:最终纳入1689份问卷,其中经验丰富者95名,经验欠丰富者1594名。①在基本情况的比较中,经验丰富者在三级医院、生殖内分泌专科的占比高于经验欠丰富者(P<0.05);经验丰富者预估患者合并胰岛素抵抗(>30%)及预估合并超重或肥胖(30%~50%)的占比高于经验欠丰富者(P<0.05)。②不同经验者对PCOS及其合并症的评估方法的差异无统计学意义(P>0.05)。Logistic回归提示,不同经验者并未对雄激素、75 g口服葡萄糖耐量试验(OGTT)及血脂的检测评估产生显著影响(P>0.05)。③对无生育需求者,不同经验者在治疗上的选择差异无统计学意义(P>0.05);对有生育需求者,与经验欠丰富者比较,经验丰富者更积极选择二甲双胍和来曲唑(P<0.05)。在减重方面,经验丰富者与经验欠丰富者都更倾向于选择二甲双胍1.0 g/d,但经验丰富者主张选择1.5 g/d的比例显著高于经验欠丰富者(P<0.05)。结论:不同经验参与者在疾病评估方法上无明显差异,但治疗上,经验丰富者更能兼顾PCOS带来的多系统异常,特别是对于有生育需求者促孕、改善代谢及降雄方面给出更全面、更准确的治疗意见。

Objective:To investigate the differences in understanding and diagnosis of polycystic ovary syndrome(PCOS)among obstetricians and gynecologists with different clinical experiences,in order to promote communication and improve medical quality.Methods:This was a multi-center cross-sectional survey.Information on participants′basic information and their knowledge of PCOS comorbidities and treatment management was collected online.Physicians were divided into two groups according to their experience:experienced(>200 consultations/year)and inexperienced(≤200 consultations/year).The differences in the diagnosis and treatment of PCOS among different groups were compared.Logistic regression analysis was used to explore other factors that might influence the diagnosis and treatment of PCOS.Results:1689 questionnaires were finally included,among which 95 were experienced and 1594 were inexperienced.①In the comparison of basic conditions,the proportion of experienced persons in tertiary hospitals and reproductive endocrinology specialties was higher than that of inexperienced persons(P<0.05);The percentage of experienced persons who predicted patients with comorbid insulin resistance(proportion>30%)and predicted comorbid overweight/obesity(proportion 30%-50%)was higher than that of less experienced persons(P<0.05).②There was no significant difference in the evaluation of PCOS and its complications among different groups(P>0.05).Logistic regression suggested that different experiencers did not significantly affect the assessment of androgens,OGTT and lipid testing(P>0.05).③There was no statistical significance in the choice of treatment for those with no fertility need(P>0.05).For those with fertility needs,metformin and letrozole were more actively selected by experienced group than inexperience(P<0.05).In terms of weight loss,experienced participants were more active in using metformin(P<0.05)and were more likely to choose 1.0 or 1.5 g/d(P<0.05)than those with inexperience.Conclusions:There was no significant difference in PCOS assessment among participants with different exp erience,but in treatment,experienced participants were better able to take into account the multi-system abnormalities brought by PCOS,and at the same time,they give more comprehensive and accurate treatment opinions on patients with or without fertility needs.