干部保健对象中他汀类药物临床应用现状分析  

Analyses of clinical application of statin drugs in cadres

作　　者：陈书艳[1] 王燕[1] 曹青[1] 顾晔[1] 杨丹英[1] 施金莹[1] 王烨[1] 马婵娟[1] 蒋雪妹[1] 

机构地区：[1]上海交通大学医学院附属新华医院老年科,200092

出　　处：《中国医药》2010年第6期509-511,共3页China Medicine

摘　　要：目的 了解干部保健人群中,他汀类药物在冠状动脉粥样硬化性心脏病（冠心病）一、二级预防中的应用情况及其与指南的差距,并分析可能的原因.方法 观察2009年8月至10月定点在我院体检的干部保健对象共767人,通过问卷调查及查阅既往病史、体格检查和实验室检查的结果,将研究对象进行危险分层,了解研究对象应用他汀类药物的情况、治疗效果与指南的差距并分析可能的原因.结果 接受调查的干部保健对象中,符合心血管疾病危险分层的高危和极高危者522例,占68.06%.符合标准并已经接受过或正在接受他汀类药物治疗者185人,占符合药物治疗标准者的41.67%.符合治疗标准而未接受他汀类药物治疗者259人,占符合药物治疗标准者的58.33%.其中医生未处方他汀类药物或处方其他降脂药193人,是患者未接受他汀类药物治疗的主要原因,占未用他汀类药物原因的43.47%.Logistic回归分析显示：医生是否处方他汀类药物主要与年龄、冠状动脉血运重建、周围血管动脉硬化有关（P＜0.05）.结论 干部保健对象中他汀类药物临床应用与指南有很大的差距,关键因素在医生,应加强医生对指南的学习,同时应加强对患者的健康教育.Objective To evaluate the statin use among cadres in primary and secondary prevention of coronary heart disease and analyse the potential cause of the difference with the current guidelines.Methods From August to October 2009, 767 cases were randomly enrolled in this research.Clinical data including past medical history, cardiovascular risk factors, and laboratory tests were collected.Risk stratification was determined based on the 2007 Guide to China lipid control.The use of statin and the difference between the guideline was observed.Logistic regression analysis was used to identify the potential cause.Results Totally 68.08% of cases were at high and very high risk of cardiovascular disease.The rate of statin use among such patient population was 41.67%.However, 259 patients with indications for statin were not on drug use, which accounted for 58.33% of the studied subjects.The main cause of statin underuse was due to non-prescription by physicians, which accounted for 43.47% of all causes.Logistic regression analysis suggested that statin prescription was significantly associated with age, coronary revascularization and peripheral artery atheresclerosis （P 〈0.05）.Conclusions There is a big gap between current clinical practice and application of guidelines in statin treatment.Clinical doctor as a key factor point should learn more about the guideline and advocate to patients.

关 键 词：他汀类药物 冠心病 血脂 危险分层 

分 类 号：R541.4[医药卫生—心血管疾病]