中国东部城市急性心肌梗死住院患者他汀药物应用十年趋势及影响因素

发布时间：2018-02-12 10:32

本文关键词： 心肌梗死降血脂药趋势　出处：《中国循环杂志》2017年08期 　论文类型：期刊论文

【摘要】：目的:评估2001~2011年间中国东部城市急性心肌梗死(AMI,包括ST段抬高型和非ST段抬高型心肌梗死)患者住院期间他汀药物应用的变化趋势,并探讨影响其使用的因素。方法:采用两阶段随机抽样设计,抽取东部城市AMI患者代表性样本。第一阶段,采用简单随机抽样确定协作医院。第二阶段,选取2001年、2006年和2011年3个特定年份,在协作医院中采用系统随机抽样方法,抽取研究病历,提取临床信息,计算院内他汀药物使用率。采用广义估计方程的多水平Logistic回归模型分析影响他汀使用的因素。结果:共计32家医院的5 940份AMI病历纳入研究。2001~2011年,AMI患者院内他汀药物的使用率从2001年的46.0%增加到2006年的82.2%和2011年的93.7%(趋势P0.001)。多因素模型分析中,低密度脂蛋白胆固醇(LDL-C)水平3.37 mmol/L的患者比LDL-C1.81 mmol/L的患者更容易接受他汀治疗[比值比(OR)=1.59;95%可信区间(CI):1.10~2.30,P=0.013],入院有胸痛(OR=1.82;95%CI:1.14~2.91,P=0.012)、合并高血压(OR=1.44;95%CI:1.02~2.03,P=0.038)、院内接受经皮冠状动脉介入治疗(OR=2.99;95%CI:1.71~5.23,P0.001)的患者也更容易接受他汀药物治疗。他汀药物使用率随LDL-C水平的降低而降低,21.3%的患者住院期间未测量血脂水平,未测量LDL-C的患者院内接受他汀药物治疗的比例最低。结论:过去的十年间,我国东部城市AMI住院患者的他汀药物使用率大幅增长,指南对于他汀药物的推荐在临床实践中得到快速普及。但是,他汀药物应用仍然存在改善空间,尤其是在院内未测量LDL-C和LDL-C水平较低的患者中,仍需强调所有AMI患者,无论LDL-C如何均应采用他汀药物治疗。
[Abstract]:Objective: To evaluate the 2001~2011 from the eastern city of Chinese acute myocardial infarction (AMI, including ST elevation and non ST elevation myocardial infarction) of hospitalized patients during application of statins, and to explore the factors affecting its use. Methods: using two stage random sampling design, from the eastern city of AMI with a representative sample. The first stage, using simple random sampling to determine the cooperative hospital. In the second stage, from 2001, 2006 and 2011 3 a particular year, systematic random sampling method is adopted in the cooperative hospitals, extraction of medical records, clinical information extraction, calculation of statin use rate. Using generalized estimating equations for multilevel Logistic regression model to analyze the influencing factors statin use. Results: 5940 cases of AMI total of 32 hospitals were included in the study of.2001~2011, AMI in patients with statin use rate from 46% in 2001 Increased to 82.2% in 2006 and 2011 93.7% (P0.001 for trend). Multiple factor analysis model, low density lipoprotein cholesterol (LDL-C) level of 3.37 mmol/L patients than LDL-C1.81 mmol/L patients were more likely to receive statin therapy [odds ratio (OR) =1.59; 95% confidence interval (CI): 1.10~2.30, P=0.013], a hospital chest pain (OR=1.82 95%CI:1.14~2.91, P=0.012;), hypertension (OR=1.44; 95%CI:1.02~2.03, P=0.038), underwent percutaneous coronary intervention in hospital (OR=2.99; 95%CI:1.71~5.23, P0.001) were more likely to receive statins. Statins use rate decreased with the level of LDL-C and decrease blood lipid levels during the period of hospitalization 21.3% of the patients, statin therapy did not measure LDL-C patients accept the lowest proportion. Conclusion: in the past ten years, China's eastern city of AMI in patients with statin use rate increase, guide For statins recommended in clinical practice has been rapidly spread. However, statin application still exists room for improvement, especially in the hospital did not measure LDL-C and patients with lower levels of LDL-C, still need to emphasize that all patients with AMI, no matter how LDL-C should be treated with statin drugs.

【作者单位】：北京协和医学院中国医学科学院国家心血管病中心阜外医院国家心血管疾病临床医学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】：卫生公益性行业科研专项“冠心病医疗结果评价研究和临床转化研究”(201202025) 国家科技支撑计划项目“冠心病医疗质量改善研究”(2013BAI09B01)
【分类号】：R542.22

【相似文献】