中国东部城市医院急性心肌梗死患者心肌标志物检测情况十年趋势——China PEACE回顾性研究结果

发布时间：2018-03-20 06:09

本文选题：心肌梗死　切入点：肌钙蛋白　出处：《中国全科医学》2017年32期 　论文类型：期刊论文

【摘要】：目的研究2001—2011年我国东部城市医院急性心肌梗死(AMI)患者心肌标志物检测情况。方法于2011年10月—2013年6月,"冠心病医疗结果评价和临床转化研究"(China PEACE)回顾性AMI研究通过两阶段随机抽样获得临床资料:第一阶段从东部城市的最高级别医院进行随机抽样,确定协作医院;第二阶段,从每家协作医院提供的2001年、2006年和2011年出院诊断为AMI的住院患者中抽取病历。收集协作医院的基本信息及AMI患者临床资料,分析医院心肌标志物(肌酸激酶同工酶和肌钙蛋白)检测的开展情况和AMI患者心肌标志物检测率的时间变化趋势,以及在开展肌钙蛋白检测的医院中,AMI患者肌钙蛋白检测率的分布情况。结果共计32家东部城市医院,5 667份AMI病历纳入研究。2001年、2006年和2011年分别为27、29、32家医院。2001年、2006年和2011年AMI患者分别为1 003、1 579、3 085例。2001年、2006年和2011年开展任意一种心肌标志物检测的医院比例分别为96.3%(26/27)、96.6%(28/29)和100.0%(32/32),不同年份开展心肌标志物检测的医院比例比较,差异无统计学意义(检验统计量值=-0.975,P=0.330)。2001年、2006年和2011年开展肌钙蛋白检测的医院比例分别为55.6%(15/27)、79.3%(23/29)和96.9%(31/32),肌钙蛋白检测的医院比例呈逐年增长趋势(检验统计量值=-3.831,P0.001)。2001年、2006年和2011年AMI患者心肌标志物检测率分别为83.75%(840/1 003)、90.44%(1 428/1 579)和95.79%(2 955/3 085),AMI患者心肌标志物检测率呈逐年增长趋势(检验统计量值=-12.661,P0.001)。2001年、2006年和2011年AMI患者肌钙蛋白检测率分别为30.91%(310/1 003)、52.56%(830/1 579)和72.41%(2 234/3 085),AMI患者肌钙蛋白检测率呈逐年增长趋势(检验统计量值=-24.190,P0.001)。2001年、2006年和2011年各医院间AMI患者肌钙蛋白检测率比较,差异均有统计学意义(χ_(2001)~2=653.145,P0.001;χ_(2006)~2=1 080.538,P0.001;χ_(2011)~2=1 372.946,P0.001)。2011年,开展肌钙蛋白检测的医院中,AMI患者肌钙蛋白检测率80.0%的仅占64.5%(20/31)。结论 2001—2011年,东部城市医院心肌标志物的检测已逐渐普及,大部分医院开展了肌钙蛋白检测,但AMI患者肌钙蛋白的检测率有待提高。东部城市医院AMI的诊疗过程存在亟待改善之处,临床实践对诊疗指南的依从性有待进一步提高。
[Abstract]:Objective to study the detection of myocardial markers in patients with acute myocardial infarction (AMI) in urban hospitals of eastern China from 2001 to 2011. Methods from October 2011 to June 2013, retrospective AMI study on coronary heart disease was conducted. After two stages of random sampling, clinical data were obtained: in the first stage, random sampling was conducted from the highest level hospitals in the eastern city. In the second stage, medical records were taken from the hospitalized patients who were diagnosed as AMI in 2001, 2006 and 2011 provided by each collaborative hospital. The basic information of the hospital and the clinical data of AMI patients were collected. To analyze the development of myocardial markers (creatine kinase isoenzyme and troponin) in hospital and the time trend of detecting rate of myocardial markers in patients with AMI. And the distribution of cardiac troponin detection rate in the hospitals where cardiac troponin was detected. Results A total of 5 667 AMI cases were included in 32 eastern city hospitals. In 2001, 2006 and 2011, there were 2729 932 hospitals respectively. In 2001, 2006 and 2006, respectively, the proportion of hospitals carrying out any kind of myocardial marker detection was 96. 3 / 26 / 27 and 96. 662 / 28 / 29) and 10. 00.0g / 32 / 32 / 32 respectively. The proportion of hospitals carrying out myocardial marker detection in different years was compared. In 2001, 2006 and 2011, the proportion of hospitals carrying out cardiac troponin detection was 55.6 / 27 / 79.33 / 29, respectively) and 96.990 / 31 / 32 / 32 respectively. The proportion of hospitals tested for troponin showed an increasing trend year by year (statistical value: -3.831 / P 0.001). The detection rates of myocardial markers in patients with AMI were 83.75 / 840 / 1 003 and 90.4444 / 1 428/1 579, respectively, and the detection rates of myocardial markers in patients with AMI were increasing year by year (statistical value: -12.661g, P 0.001). In 2001, 2006 and 2006, the detection rates of cardiac troponin were 30.91and 310.1 / 1, respectively. The cardiac troponin detection rate in the patients with acute myocardial infarction (AMI) showed an increasing trend year by year (statistical value: -24.190P0.001). In 2001, 2006 and 2011, the cardiac troponin detection rate of patients with AMI was compared between 2001, 2006 and 2011, and the results were as follows: (1) in 2001, in 2006, and in 2011, there was a significant increase in the detection rate of cardiac troponin in patients with acute myocardial infarction (AMI). The difference was statistically significant (蠂 ~ 1 / 2001 / 653 / 145 / P0.001; 蠂 / T / 2006 / 1 / 0080.538/ P 0.001; 蠂 ~ + / 2011 / 2011 / 21.372.946n / P 0.001. in 2011, only 64.5 / 2031s / 2031A) of cardiac muscle markers were detected in hospitals where cardiac troponin detection was carried out. Conclusion from 2001 to 2011, the detection of cardiac muscle markers in eastern urban hospitals has become more and more popular. Most hospitals carried out cardiac troponin detection, but the detection rate of cardiac troponin in AMI patients needs to be improved, the diagnosis and treatment process of AMI in eastern city hospital needs to be improved urgently, and the compliance of clinical practice to the diagnosis and treatment guidelines needs to be further improved.
【作者单位】：中国医学科学院北京协和医学院国家心血管病中心中国医学科学院阜外医院国家心血管病临床研究中心心血管疾病国家重点实验室中国牛津国际医学研究中心;
【基金】：国家卫生和计划生育委员会卫生公益性行业科研专项(201202025,201502009) 国家科技部科技支撑计划(2015BAI12B01,2015BAI12B02) 高等学校学科创新引智计划资助(B16005)
【分类号】：R542.22

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