慢性缺血性心力衰竭患者指南指导下的用药现状  

Current status of guideline-directed medical therapy for patients with chronic ischemic heart failure

作　　者：王洁[1] 蒋捷[1] 褚松筠[1] 杨颖[1] 刘琳[1] 赵静[1] 霍勇[1] 丁文惠[1] WANG Jie;JIANG Jie;CHU Song-yun;YANG Ying;LIU Lin;ZHAO Jing;HUO Yong;DING Wen-hui(Department of Cardiology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院心内科

出　　处：《中国临床药理学杂志》2019年第24期3183-3186,共4页The Chinese Journal of Clinical Pharmacology

摘　　要：目的 分析在我国三甲医院中慢性缺血性射血分数减低的心力衰竭(HFr EF)患者的血管紧张素转换酶抑制药(ACEI)/血管紧张素受体拮抗药(ARB)、β受体阻滞药、螺内酯的应用情况,并分析其应用剂量及与剂量的相关因素。方法 从“评估标准心衰治疗加用米屈肼胶囊(JSC Grindeks) 500 mg,bid治疗慢性缺血性心力衰竭患者有效性和安全性的双盲、随机、安慰剂平行对照、多中心的临床研究”入选的患者中提取基线资料,分析应用ACEI/ARB、β受体阻滞药、螺内酯的患者比例,以及ACEI/ARB、β受体阻滞药的剂量及其相关的因素。结果 该试验入选了467例医生认为已达到最佳的药物治疗和稳定状态的门诊慢性缺血性心力衰竭患者,其中女性占16. 27%,平均年龄(62. 49±9. 67)岁,基线氨基末端脑钠肽前体(NT-pro BNP)水平为624. 90(252. 70~1464. 00) pg·m L-1。基线左室射血分数为36. 00%(32. 00%~38. 20%)。ACEI/ARB、β受体阻滞药、螺内酯的应用比例分别为82. 65%,89. 50%,70. 88%。接受低剂量(<50%靶剂量)、中剂量(≥50%且<100%靶剂量)及高剂量(≥100%靶剂量)的ACEI/ARB患者分别为62. 64%,33. 62%及3. 74%。接受低、中、高剂量β受体阻滞药的患者分别为84. 10%,10. 12%和5. 78%。和低剂量ACEI/ARB组相比,中高剂量ACEI/ARB组的糖尿病比例更高(45. 38%vs 30. 27%,P <0. 01)。低剂量和中高剂量β受体阻滞药2组基线特征的差异无统计学意义。结论 在我国三甲医院的临床环境中,慢性缺血性HFr EF患者中接受ACEI/ARB、β受体阻滞药和螺内酯治疗的比例较高,但达到靶剂量的患者比例很低。未来需要更多的措施以进一步优化HFr EF患者的治疗。Objective To analyze the application status of angiotensinconverting enzyme inhibitors(ACEI)/angiotensin receptor antagonist(ARB),β-blockers and spironolactone in patients with chronic ischemic heart failure with reduced ejection fraction(HFrEF)in Chinese tertiary hospitals,and to explore the prescribing dose and dose-associated factors.Methods Baseline data were obtained from patients enrolled in a double-blind,randomized,parallel placebo-controlled,multicenter clinical study evaluating the efficacy and safety of Mildronate Capsules(JSC Grindeks)500 mg bid adding to standardized heart failure treatment for chronic ischemic heart failure.We analyzed the proportion of patients receiving ACEI/ARB,β-blockers and spironolactone,and the prescribingdose of ACEI/ARB andβ-blockers,as well as dose-associated factors.Results The trial enrolled 467 patients with chronic ischemic heart failure,who were considered by doctors to have received optimal medical treatment and reached stable status.The mean±SD age of the patients was(62.49±9.67)years old,and 16.27%were women.Baseline NT-proBNP level was 624.90(252.701464.00)pg·mL-1,and baseline left ventricular ejection fraction was 36.00%(32.00%38.20%).The proportion of patients receiving ACEI/ARB,β-blockers and spironolactone was 82.65%,89.50%and 70.88%,respectively.The proportion of patients receiving low(<50%target dose),intermediate(≥50%and<100%target dose),and high dose(≥100%target dose)of ACEI/ARB was 62.64%,33.62%,and 3.74%,respectively.The proportion of patients receiving low,intermediate,and high dose ofβ-blockers was 84.10%,10.12%and 5.78%,respectively.Compared with the low-dose ACEI/ARB group,the intermediate/high-dose ACEI/ARB group had a higher proportion of diabetes mellitus(45.38%vs 30.27%,P<0.01).There were no significant differences in baseline characteristics between the low-dose and intermediate/high-doseβ-blockers groups.Conclusion In the clinical environment of tertiary hospitals in China,the proportion of patients with chronic ischemic HFrEF rece

关 键 词：射血分数减低的心力衰竭 治疗 靶剂量 

分 类 号：R972[医药卫生—药品]