β受体阻滞剂在中国稳定性心绞痛患者中的使用及其影响因素  

Current status and influence factors of beta blocker prescription in Chinese patients with stable angina pectoris

作　　者：蒋捷[1] 王新刚[1] 贾佳[1] 霍勇[1] 

机构地区：[1]北京大学第一医院心内科,100034

出　　处：《中华心血管病杂志》2015年第3期227-233,共7页Chinese Journal of Cardiology

摘　　要：目的 描述中国稳定性心绞痛患者使用β受体阻滞剂的现状,比较临床实际应用与治疗指南的差异及其影响因素.方法 2011年在全国298家医院进行了慢性稳定性心绞痛患者药物治疗依从性调查,收集患者临床信息及用药信息.根据调查时是否服用β受体阻滞剂将患者分为用药组和未用药组,比较两组患者的就诊医院特征、人口学特征、心血管危险因素、冠心病诊断方法、冠状动脉血运重建史、其他冠心病二级预防用药,采用二元logistic回归方法分析与β受体阻滞剂使用相关的因素.在基线调查3个月后对患者进行1次随访,对基线时服用β受体阻滞剂的患者,根据其是否仍在使用β受体阻滞剂分为依从治疗组与未依从治疗组,比较2组患者临床特征,分析影响使用β受体阻滞剂依从性的因素.结果 共收集5 011份有效问卷.男2 859例,女2 152例,平均年龄（67.6±11.5）岁,其中3 060例（61.1％）使用了β受体阻滞剂.多因素分析显示,校正其他因素后,年龄较大的患者较少使用β受体阻滞剂（OR=0.895,95％ CI 0.849～0.944,P＜0.001）,合并高血压病（OR=1.255,95％ CI1.103～1.427,P=0.001）或高脂血症（OR=1.456,95％ CI 1.287～1.648,P＜0.001）、经影像学确诊冠心病（OR=1.250,95％ CI 1.070～1.461,P=0.005）、有冠状动脉血运重建史者（OR=1.490,95％CI 1.220～1.820,P＜0.001）β受体阻滞剂使用比例较高.基线调查时使用β受体阻滞剂的3 060例患者中,3个月复诊时依从治疗的患者为2 533例（82.8％）.多因素分析显示,校正其他因素后,中医医院就诊（OR=1.612,95％ CI1.154 ～2.251,P=0.005）、教育程度较低（OR=1.316,95％ CI 1.151～1.504,P＜0.001）、合并高血压病（OR=1.345,95％CI 1.096～1.651,P=0.005）、基线时诊室心率较高（OR=1.020,95％ CI 1.010 ～1.030,P＜0.001）及经影像学确诊冠心病者（OR=1.342,95％CI 1.095～1.644,P=0.005）对β受体阻滞剂的依从性较高,Objective To analyze the status of beta blockers （BBs） prescription in Chinese patients with stable angina pectoris.To determine the gap between clinical practice and treatment guidelines and factors influencing the use of BBs in Chinese patients.Method A questionnaire survey was conducted in patients diagnosed with chronic stable angina pectoris in 2011.A total of 298 Chinese hospitals attended the survey.The questionnaire collected patient demographic information,clinical and medication information.In the analysis,patients were divided into two groups according to whether they were on BBs at the time of the interview.Hospital characteristics,patient demographic information,cardiovascular risk factors,diagnostic method of coronary heart disease,past history of coronary revascularization and use of secondary prevention medications were compared between the two groups.Binary logistic regression analysis was used to identify factors related to BBs use.Patients were followed-up for 3 months.Patients who were on BBs at baseline were divided into two groups according to whether they were still on BBs after 3 months.Comparison of the clinical information previously mentioned was made between the two groups,and binary logistic regression analysis was used to identify factors related to BBs adherence.Results Of the 5 011 questionnaires,2 859 cases were male,mean age was （67.6 ± 11.5）years old,3 060 （61.1％） patients were on BBs at baseline.Binary logistic regression analysis showed that when adjusted for other factors,old age （OR =0.895,95％ CI 0.849-0.944,P ＜0.001） was related to no BBs use,while comorbidity with hypertension （OR =1.255,95％ CI 1.103-1.427,P =0.001） or hyperlipidemia （OR =1.456,95％ CI 1.287-1.648,P ＜ 0.001）,diagnosed with coronary disease by imaging （OR =1.250,95％ CI 1.070-1.461,P =0.005） and past history of coronary revascularization （OR =1.490,95％ CI 1.220-1.820,P ＜ 0.001） were related to higher percentage of BBs use.A total of 2 533 cases （82.8％）

关 键 词：冠状动脉疾病 肾上腺素能Β受体拮抗剂 病人依从 

分 类 号：R541.4[医药卫生—心血管疾病]