2001-2011年中国东部城市急性心肌梗死患者血管紧张素转化酶抑制剂和血管紧张素受体阻滞剂的应用及影响因素——China PEACE回顾性急性心肌梗死研究  

Patterns of use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers among patients with acute myocardial infraction in Eastern Urban China from 2001 to 2011:the China PEACE-Retrospective Acute Myocardial Infarction Study

作　　者：刘佳敏[1] 霍西茜[1] 白雪珂 冯芳[1] 张丽华[1] 蒋立新[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心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,北京市100037

出　　处：《中国分子心脏病学杂志》2017年第1期1945-1950,共6页Molecular Cardiology of China

基　　金：卫生公益性行业科研专项(编号:201202025);国家科技部科技支撑计划(2013BAI09B01;2015BAI12B01和2015BAI12B02)

摘　　要：目的评价2001-2011年间中国东部城市地区急性心肌梗死(acute myocardial infarction,AMI)血管紧张素转化酶抑制剂(angiotensin-converting enzymeinhibitors,ACEIs)和血管紧张素受体阻滞剂(angiotensin receptor blockers,ARBs)的使用情况及影响因素。方法采用China PEACE回顾性AMI研究的数据,通过两阶段随机抽样获得2001、2006和2011年有代表性的东部城市AMI患者的临床信息。为估算出三个研究年份ACEI/ARB的使用率和变化趋势,对每年度的数据分别进行加权计算,以代表东部城市整体情况。采用二元logistic回归方法分析其使用的影响因素。结果 32家东部城市医院参加研究,入选5436份AMI病例,其中中国指南Ⅰ类推荐组5309例,Ⅱa类推荐组127例。2001、2006和2011年,指南Ⅰ类推荐患者ACEI/ARB加权使用率分别为61.5%、74.3%和65.8%,无明显改善(趋势P值=0.51);指南Ⅱa类推荐患者为30.0%、25.9%和49.3%,有明显改善(趋势P值=0.03)。在3个研究年份中,ACEIs使用率均显著高于ARBs。多因素分析显示,合并高血压(OR 2.50,95%CI 2.2-2.84)、糖尿病(OR1.27,95%CI 1.08-1.49)和心力衰竭(OR1.51,95%CI 1.15-1.97)的患者更倾向于使用ACEI/ARB;与入院时收缩压90-139mm Hg相比,收缩压≥140mm Hg(OR 1.86,95%CI 1.59-2.18)的患者更容易接受ACEI/ARB。相反,女性患者(OR 0.76,95%CI 0.63-0.92)、非前壁ST段抬高型心肌梗死(OR 0.65,95%CI0.55-0.76)、非ST段抬高型心肌梗死(OR 0.73,95%CI 0.57-0.94)、合并心源性休克(OR 0.70,95%CI 0.55-0.88)和估计肾小球滤过滤<60 ml/min/1.73 m^2(OR 0.69,95%CI 0.50-0.97)的患者较少使用ACEI/ARB。结论 2001-2011年间,我国东部城市地区适宜使用ACEI/ARB的AMI患者中整体使用率明显不足,且在指南Ⅰ类推荐组中无明显改善。亟待采取针对性的质量改善措施将循证医学证据及时准确地应用到临床实践中,改善患者预后。Objective To evaluate patterns of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers （ACEI/ARB） therapy in patients with acute myocardial infarction （AMI） in China＇s eastern urban area from 2001 to 2011, and identify independent factors associated with the use of ACEI/ARB. Method Through a two-stage random sampling, a representative sample of patients in eastern urban China admitted to hospital for AMI in 2001, 2006 and 2011 was created. To generate regional estimates, we applied weights proportional to the inverse sampling fraction of patients, to account for differences in the sampling fraction for each study period. Binary logistic regression analysis was used to identify independent factors associated with the use of ACEI/ARB. Result We included 5436 eligible patients with AMI in 32 urban hospitals, of which 5309 were eligible for Class I indication by Chinese guidelines and 127 were eligible for Class lla indication. From 2001 to 2011, there was no significant change in the use of ACEI/ARB in patients with Class I indication （61.5% in 2001, 74.3% in 2006 and 65.8% in 2011 respectively, P =0.51 for trend）, but there was significant improve in those with Class lla indication （30.0% in 2001,25.9% in 2006 and 49.3% in 2011 respectively, P=0.03 for trend）. Among three specific study years, rate of ACEIs was noticeably higher than that of ARBs. Logistic regression analysis showed that patients with hypertension （OR 2.50, 95% CI 2.2-2.84）, diabetes （OR 1.27, 95% CI 1.08- 1.49）, heart failure （OR 1.51, 95% CI 1.15-1.97） were more likely to be treated with ACEI/ARB. Compared with systolic blood pressure （SBP） 90-139mm Hg at admission, patients with SBP ≥140mm Hg （OR 1.86, 95% CI 1.59-2.18） were more likely to accept ACEI/ARB therapy, while female （OR 0.76, 95% CI 0.63-0.92）, patients with non-anterior ST-elevation myocardial infarction （OR 0.65, 95% CI 0.55-0.76）, non-ST-elevation myocardial infarction （OR 0.73, 95% CI 0.57-0.94）, cardiogenic sho

关 键 词：急性心肌梗死 血管紧张素转化酶抑制剂 血管紧张素受体阻滞剂 医疗质量 

分 类 号：R542.22[医药卫生—心血管疾病]