背景:系统性轻链(AL)淀粉样变性是一种罕见的多系统疾病,与发病率增加和预后不良有关。由于症状的异质性,延迟诊断很常见。然而,尚未研究中国AL淀粉样变性患者的真实见解。
目的:本研究旨在描述AL淀粉样变性诊断的历程,并从临床医生和患者的角度深入了解诊断过程,以获得正确及时的诊断。
方法:检索了2008年1月至2021年4月期间来自社交媒体平台的公开疾病相关内容。使用机器模型执行数据收集步骤后,提取了一系列与疾病相关的帖子。自然语言处理用于识别变量的相关性,然后进行进一步的手工评估和分析。
结果:本研究共纳入2204个与AL淀粉样变性相关的有效帖子,其中1968年发布在haodf.com上。在这些帖子中,1284个由男性发布(中位年龄57,IQR46-67岁);1459个帖子提到肾脏相关症状,其次是心脏(n=833),肝脏(n=491),胃(n=368)症状。此外,1502发布了与2个或更多个器官相关的提到的症状。疑似患者最常提及的AL淀粉样变性症状是非特异性虚弱(n=252),水肿(n=196),肥大(n=168),和肿胀(n=140)。多次看医生很常见,和肾病学家(n=265)和血液学家(n=214)是最常见的专家由怀疑患者的初始会诊.此外,院际转诊也很常见,集中在三级医院。
结论:中国AL淀粉样变性患者在获得准确诊断的过程中经历了转诊。提高对疾病的认识并尽早转诊到具有专业知识的专业中心可能会减少延迟诊断并改善患者管理。
BACKGROUND: Systemic light chain (AL) amyloidosis is a rare and multisystem disease associated with increased morbidity and a poor prognosis. Delayed diagnoses are common due to the heterogeneity of the symptoms. However, real-world insights from Chinese patients with AL amyloidosis have not been investigated.
OBJECTIVE: This study aimed to describe the journey to an AL amyloidosis diagnosis and to build an in-depth understanding of the diagnostic process from the perspective of both clinicians and patients to obtain a correct and timely diagnosis.
METHODS: Publicly available disease-related content from social media platforms between January 2008 and April 2021 was searched. After performing data collection steps with a machine model, a series of disease-related posts were extracted. Natural language processing was used to identify the relevance of variables, followed by further manual evaluation and analysis.
RESULTS: A total of 2204 valid posts related to AL amyloidosis were included in this study, of which 1968 were posted on haodf.com. Of these posts, 1284 were posted by men (median age 57, IQR 46-67 years); 1459 posts mentioned renal-related symptoms, followed by heart (n=833), liver (n=491), and stomach (n=368) symptoms. Furthermore, 1502 posts mentioned symptoms related to 2 or more organs. Symptoms for AL amyloidosis most frequently mentioned by suspected patients were nonspecific weakness (n=252), edema (n=196), hypertrophy (n=168), and swelling (n=140). Multiple physician visits were common, and nephrologists (n=265) and hematologists (n=214) were the most frequently visited specialists by suspected patients for initial consultation. Additionally, interhospital referrals were also commonly seen, centralizing in tertiary hospitals.
CONCLUSIONS: Chinese patients with AL amyloidosis experienced referrals during their journey toward accurate diagnosis. Increasing awareness of the disease and early referral to a specialized center with expertise may reduce delayed diagnosis and improve patient management.