2001—2011年我国农村地区医院急性心肌梗死患者院内他汀类药物的应用  

Statin Therapy in Patients Hospitalized with Acute Myocardial Infarction in Rural China Hospital from 2001 to 2011

作　　者：严小芳[1] 张海波[1] 刘佳敏[1] 孙颖[1] 胡爽[1] 李希[1] 蒋立新[1] YAN Xiaofang;ZHANG Haibo;LIU Jiamin;SUN Ying;HU Shuang;LI Xi;JIANG Lixin(Peking Union Medical College,Chinese Academy of Medical Sciences and National Center for Cardiovascular Diseases,Fuwai Hospital,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院阜外医院国家心血管疾病临床医学研究中心

出　　处：《医药导报》2019年第8期1057-1063,共7页Herald of Medicine

基　　金：卫生公益性行业科研专项(201202025);国家科技支撑计划项目(2013BAI09B01)

摘　　要：目的评价2001—2011年我国农村地区医院急性心肌梗死(AMI)患者院内他汀类药物应用的变化趋势,并探讨其影响因素。方法采用两阶段随机抽样方法,即简单随机抽样抽取农村地区医院,系统随机抽样从抽中医院中抽取2001、2006和2011年AMI患者住院病历。提取病历中临床信息,计算他汀类药物的使用率和变化趋势,Cochran-Armitage检验使用变化趋势,多水平多因素logistic回归模型分析影响因素。结果抽取105家医院,99家参加研究。抽取2001、2006和2011年AMI住院患者病历7111份,获得6979份(98.1%),入选5664例适宜使用他汀类药物的患者。他汀类药物使用率从2001年的12.8%上升至2006年的60.4%及2011年的84.3%(趋势P值<0.001)。2001、2006和2011年使用他汀类药物的人群中,中等及以上强度他汀类药物的使用率分别是15.3%、55.7%和78.8%(趋势P值<0.001)。不同低密度脂蛋白胆固醇(LDL-C)水平及年份之间使用率差异逐渐缩小。降脂效能高的他汀类药物使用比例逐渐升高。2011年,高血压、入院时胸痛、LDL-C水平都会影响他汀类药物使用。未检测LDL-C的患者获得他汀类药物治疗的可能性相对较小,LDL-C≥1.8mmol·L^-1的患者更易接受治疗。结论2001—2011年,我国农村地区医院AMI患者院内他汀类药物可及性和应用规范性大幅提高,指南对他汀类药物的推荐在实践中快速普及,但规范使用仍存在改善空间。医疗机构及管理部门需要制定有针对性的改善措施,优化他汀类药物的应用。Objective To determine current usage rates and temporal trends in statin therapy,and to analyze factors associated with the lack of statin therapy among patients hospitalized with acute myocardial infarction( AMI) in rural China hospitals from the year 2001 to 2011. Methods A representative sample of patients in rural China admitted to hospital for AMI was created from a two-stage random sampling. A simple random-sampling procedure was used to identify participating hospitals. Patients admitted to each participating hospitals for AMI in 2001,2006,and 2011 were selected using a systematic sampling approach. Clinical information was obtained via central medical record abstraction for each patient,and then in-hospital statin use was analyzed. A multilevel logistic regression models with use of generalized estimating equations were performed to explore associated factors of the use of statin therapy. Results Among 105 sampled rural hospitals,99 hospitals participated.Totally,5664 patients were identified eligible for statin therapy to determine rates of statin use and the intensity of statin therapy.Rates of statin use among hospitalized patients with AMI in rural China increased from 12.8% in 2001 to 60.4% in 2006,and84.3% in 2011( P<0.001 for trend). Among the patients treated with statin,those receiving moderate and above intensity statin therapy increased from 15.3% in 2001 to 55.7% in 2006,and 78.8% in 2011( P<0.001 for trend). The variation in statin use in different density lipoprotein cholesterol( LDL-C) group and years decreased overtime. And in the multivariable model,several patient factors were associated with statin therapy. Patients without LDL-C measured during the hospitalization were significantly less likely to receive statin therapy. Patients with hypertension or chest pain or high level of LDL-C were associated with high possibility to receive statin therapy. Conclusion From the year 2001 to 2011 in rural China,the use of statin therapy has dramatically increased. However,gaps still persist among

关 键 词：他汀类药物 心肌梗死 急性 血脂 治疗评价 

分 类 号：R972.6[医药卫生—药品] R969.3[医药卫生—药学]