【作者】 李颖；

【导师】 郭述良；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2023， 硕士

【摘要】 目的:吸入糖皮质激素(ICS)在慢性阻塞性肺病(COPD)维持治疗中起着至关重要的作用。有的肺科医生不同意慢性阻塞性肺病诊断、管理和预防全球战略(GOLD)中使用ICS治疗COPD患者的参考指标。因此,我们对重庆地区肺科医生关于GOLD提出的使用ICS前的参考指标的看法进行调查。方法:本横断面研究遵循STROBE指南。从2022年4月至2022年10月,我们通过重庆市呼吸质量控制中心等多平台采集便利样本。本研究通过自行设计的问卷对参与者进行了在线访谈,以收集参与者的社会人口学数据,并将GOLD建议启用ICS前应参考的指标作为标准,评估参与者在开具ICS处方前如何参考上述标准。结果:共有381名肺科医生参与了这项研究,所有参与者均不能在门诊和病房工作中全程参考GOLD提出的参考指标。在所有的参与者中,有344人(90.29%)阅读过GOLD,更年轻和来自三级医院的参与者对GOLD提出的参考指标的熟悉程度更高(P<0.05)。仅42名(11.0%)参与者在门诊工作中对COPD患者使用ICS前完全参考GOLD提出的支持或拒绝使用ICS的指标。无论是在门诊还是病房工作期间,将“血嗜酸性粒细胞计数(EOS)”作为决定使用ICS的参考指标的参与者均最少,分别为84人(22.0%)和186人(48.8%)。76人(20.0%)在所有工作时间中始终将EOS作为评估是否开具ICS处方的参考指标。36.5%(139/381)的参与者认为EOS水平稳定性差以及EOS水平升高的慢阻肺患者偏少。结论:重庆地区的肺科医生对GOLD建议使用ICS的参考指标整体接受度不高,只有少数肺科医生会将EOS水平作为评估COPD患者是否应用含ICS的治疗方案的参考指标之一。更多还原

【Abstract】 Objectives: Inhaled corticosteroids(ICS)play a crucial role in maintenance therapy for chronic obstructive pulmonary disease(COPD).Some pulmonologists disagree with the reference recommendation in the Global Strategy for the Diagnosis,Management and Prevention of COPD(GOLD)to use ICS in patients with COPD.Therefore,we investigated the perceptions of pulmonologists in Chongqing regarding the reference recommendations for the use of ICS proposed by GOLD.Methods: This cross-sectional study followed the STROBE guidelines.From April 2022 to October 2022,convenient samples were collected through multiple platforms such as the Chongqing Respiratory Quality Control Center.Participants were interviewed online using a self-designed questionnaire to collect sociodemographic data,and GOLD’s proposed metrics for pre-commissioning ICS were used as criteria to assess how participants would refer to the above criteria before prescribing ICS.Results: A total of 381 pulmonologists participated in the study.Participants were not able to refer to GOLD’s recommendations throughout their outpatient and ward work.Among all participants,344(90.29%)had read GOLD,and participants who were younger or from tertiary hospitals were more familiar with the references proposed by GOLD(P<0.05).Only42 participants(11.0%)fully referred to GOLD for supporting or rejecting the use of ICS in outpatient work for COPD patients.The fewest participants used "blood eosinophil count(EOS)" as a reference for their decision to use ICS during either outpatient or ward work,84(22.0%)and186(48.8%)participants,respectively.76(20.0%)consistently cited EOS as a reference for prescribing ICS throughout all work hours.36.5%(139/381)of participants reported poor stability of EOS levels and a small number of COPD patients with elevated EOS levels.Conclusions: The overall acceptance of GOLD’s recommendation to use ICS was not high among pulmonologists in Chongqing,and only a small number of pulmonologists would use EOS level as a reference to evaluate the use of ICS-containing treatment options in COPD patients.更多还原