Table 1_Knowledge, attitudes, and practices of Chinese endocrinologists on congenital adrenal hyperplasia: emphasis on fertility management and diagnostic challenges.docx

IntroductionThis study aimed to evaluate the knowledge, attitudes, and practices (KAP) of Chinese endocrinologists regarding congenital adrenal hyperplasia (CAH), which is essential for enhancing clinical differentiation skills and improving fertility management in non-classic CAH patients.
MethodsThis cross-sectional study was conducted between July 27 and August 23, 2023, using a questionnaire distributed to 475 endocrinologists across China. KAP levels were assessed using a 70% maximum score threshold for descriptive purposes, and factors associated with KAP were identified via multivariate logistic regression.
ResultsThe median scores were 21/27 (knowledge), 35/40 (attitudes), and 28/35 (practices). Despite positive attitudes, significant gaps in fertility-related knowledge were evident: nearly 30% of respondents failed to recognize that female CAH patients could achieve natural pregnancy through proper individualized treatment, and 24% failed to identify fertility preservation as a key treatment goal. Diagnostic confidence was also limited (53.9%), with over half of participants unclear on the most common enzyme deficiencies crucial for differential diagnosis. Logistic regression analysis revealed that having a doctoral degree, an intermediate or senior professional rank, and experience in diagnosing CAH were associated with more proactive clinical practices, especially in patient education and reproductive health counseling.
ConclusionWhile Chinese endocrinologists demonstrate generally positive attitudes toward CAH, significant knowledge and practice gaps persist, particularly in fertility management and diagnostic differentiation. The limited awareness of reproductive outcomes and low diagnostic confidence highlight an urgent need for targeted education to improve individualized fertility treatment options and reduce misdiagnosis in clinical practice.

引言 本研究旨在评估中国内分泌科医师对先天性肾上腺皮质增生症（congenital adrenal hyperplasia, CAH）的知识、态度与实践（Knowledge, Attitudes, Practices, KAP）现状，这对提升非经典型CAH患者的临床鉴别能力与生育管理水平至关重要。
方法 本研究为横断面研究，于2023年7月27日至8月23日期间开展，通过问卷向全国475名内分泌科医师进行调研。本研究以满分70%作为评分阈值对KAP水平进行描述性评估，并通过多因素logistic回归分析筛选与KAP水平相关的影响因素。
结果 本次调研的中位得分分别为：知识维度21/27、态度维度35/40、实践维度28/35。尽管医师群体对CAH的态度整体积极，但在生育相关知识方面仍存在显著缺口：近30%的受访者未能认识到，女性CAH患者经个体化规范治疗后可实现自然妊娠；另有24%的受访者未将生育力保存视为核心治疗目标。诊断自信心也较为薄弱，仅53.9%的医师具备足够的诊断信心，超过半数参与者对鉴别诊断所需的常见酶缺陷认知不清。多因素logistic回归分析显示，拥有博士学位、中级及以上专业职称，以及具备CAH诊疗经验的医师，其临床实践行为更为积极主动，尤其体现在患者教育与生殖健康咨询方面。
结论 尽管中国内分泌科医师对CAH的整体态度较为积极，但在知识储备与临床实践方面仍存在显著不足，尤其在生育管理与诊断鉴别领域。对生殖预后的认知不足与诊断自信心匮乏，凸显了开展针对性教育培训的迫切性，以优化个体化生育治疗方案并降低临床诊疗中的误诊率。