上海市浦东新区全科医生甲状腺结节及分化型甲状腺癌相关知识了解情况调查

背景　目前我国甲状腺结节的患病率为20%~76%，已成为内分泌系统的第二大疾病。早发现、早诊断、早治疗是防治甲状腺肿瘤的有效措施，全科医生在其中发挥着重大作用。但是，社区卫生服务中心对甲状腺疾病的管理还存在许多不足之处。目的　了解上海市浦东新区全科医生对甲状腺结节及分化型甲状腺癌（DTC）相关知识的了解情况，发现不足之处并提出改进方法，以期推进甲状腺疾病分级诊疗。方法　于2017-12-20至2018-01-10，依据上海市浦东新区的城乡划分，即城镇地区、城郊结合地区、郊区，使用计算机在各区随机整群抽取3家社区卫生服务中心的全部全科医生为调查对象，采用问卷星形式进行调查，调查内容包括一般资料、甲状腺结节的良恶性评估、甲状腺结节术前及术后管理、DTC术后促甲状腺激素（TSH）抑制治疗和管理及全科医生甲状腺疾病管理能力自我评估。结果　本研究共发放问卷309份，回收307份，有效回收率为99.4%。在全科医生对甲状腺结节良恶性的评估方法的了解情况评估中，对电子计算机断层扫描、磁共振成像及2-氟-2-脱氧D-葡萄糖正电子发射断层显像术，TSH，甲状腺球蛋白的了解程度，不同职称和学历全科医生之间比较，差异均有统计学意义（P<0.05）；不同职称全科医生对血清降钙素的了解程度比较，差异有统计学意义（P<0.05）。在全科医生对甲状腺结节术前及术后管理的了解情况评估中，不同职称全科医生对甲状腺结节术前随访时间、细针穿刺抽吸活检适应证和术后TSH抑制治疗、左甲状腺素替代治疗的了解程度比较，差异均有统计学意义（P<0.05）；不同学历全科医生对甲状腺结节术前随访时间、131I治疗的适应证和禁忌证的了解程度比较，差异均有统计学意义（P<0.05）。在全科医生对DTC术后TSH抑制治疗和管理的了解情况评估中，不同职称全科医生对术后首选L-T4口服制剂、L-T4服用方法、L-T4剂量调整、TSH水平监测的了解程度比较，差异均有统计学意义（P<0.05）；不同学历全科医生对L-T4剂量调整、心脏监测的了解程度比较，差异均有统计学意义（P<0.05）。全科医生对甲状腺结节良恶性评估方法的了解情况得分为（19.1±6.9）分、对甲状腺结节术前与术后管理的了解情况得分为（14.0±7.2）分和对DTC术后TSH抑制治疗和管理的了解情况得分为（13.7±8.4）分，不同学历、职称全科医生对这3部分相关知识的了解情况得分以及总分比较，差异均有统计学意义（P<0.05）；且不同职称、学历全科医生对甲状腺疾病管理能力自我评估比较，差异均有统计学意义（P<0.05）。结论　上海市浦东新区全科医生对甲状腺结节及DTC相关知识的了解较为欠缺，尤其是对甲状腺结节患者的术前转诊随访及术后治疗管理、DTC患者术后TSH抑制治疗和管理的了解，且自我评估对甲状腺疾病的管理能力缺乏信心，需要加强学习和临床培训。

Survey on Knowledge about Thyroid Nodules and Differentiated Thyroid Cancer among General Practitioners in Pudong New Area of Shanghai

Background　At present，the prevalence of thyroid nodules in China is 20% to 76%，which has become the second most common disease of the endocrine system.Early detection，early diagnosis and early treatment are effective measures to prevent and treat thyroid tumors，and family doctors play a major role in it.However，there are still many shortcomings in the management of thyroid diseases in community health service centers.Objective　Through study of the knowledge about thyroid nodules and Differentiated thyroid carcinoma（DTC） among General practitioners in Pudong New Area of Shanghai，to find the shortcomings in order to propose improvement methods to promote the hierarchical diagnosis and treatment of thyroid diseases.Methods　From 20th December 2017 to 10th January，2018，according to the urban-rural division of Pudong New Area in Shanghai，through cluster sampling method，randomly selected three community health service centers by computer from urban areas，suburban areas and suburbs according to the urban-rural division of Pudong New Area in Shanghai，and the survey included general information，assessment of benign and malignant thyroid nodules，preoperative and postoperative management of thyroid nodules，treatment and management of thyrotropic hormone（TSH） inhibition after DTC，and self-assessment of thyroid disease management ability of general.Results　A total of 309 questionnaires were distributed，and 307（99.4%） of them were recovered.In the evaluation of general practitioners' understanding of the evaluation methods of benign and malignant thyroid nodules，the differences were statistically significant in the understanding of CT scan，magnetic resonance imaging，2-fluoro-2-deoxyd-glucose positron emission tomography，TSH，and thyroid globulin among general practitioners with different professional titles and educational backgrounds（P<0.05）.The differences were statistically significant in the degree of understanding of serum calcitonin among general practitioners with different professional titles（P<0.05）.In the evaluation of general practitioners' understanding of preoperative and postoperative management of thyroid nodules，the differences were statistically significant in the understanding of general practitioners with different titles on preoperative follow-up time，indications of fine needle aspiration biopsy，postoperative TSH inhibition therapy and left thyroxine replacement therapy（P<0.05）.The differences were statistically significant（P<0.05）in the understanding degree of general practitioners with different educational backgrounds on the preoperative follow-up time of thyroid nodules and understanding of indications and contraindication of 131I treatment.In the evaluation of general practitioners' understanding of TSH inhibition treatment and management after DTC，the differences were statistically significant among general practitioners with different titles in their understanding of the preferred oral preparation L-T4，L-T4 taking method，L-T4 dose adjustment and TSH level monitoring（P<0.05）.General practitioners with different education backgrounds had statistically significant differences in their understanding of L-T4 dose adjustment and heart monitoring（P<0.05）.The understanding score of general practitioners on the benign and malignant evaluation methods of thyroid nodules was（19.1±6.9），the understanding score of preoperative and postoperative management of thyroid nodules was（14.0±7.2），and the understanding score of TSH inhibition treatment and management after DTC was（13.7±8.4）.The general practitioners with different educational backgrounds and professional titles had statistically significant differences in the understanding scores of these three parts and the total scores（P<0.05）.Moreover，the self-evaluation of thyroid disease management ability of general practitioners with different professional titles and educational backgrounds was statistically significant（P<0.05）.Conclusion　GPs in Shanghai's Pudong New District relatively lack in the knowledge of thyroid nodule and DTC，especially in patients with thyroid nodule preoperative and postoperative treatment referral follow-up management，DTC patients postoperative TSH suppression therapy and management.Moreover，GPs lack confidence in the management of thyroid diseases，and it is necessary for GPs to strengthen learning and clinical training.