中国心房颤动患者抗心律失常药物的临床应用情况及处方合理性分析  

Current status of the clinical practice and analysis on the ratioanl prescription of antiarrhythmic drugs in Chinese patients with atrial fibrillation:Results from the Chinese Atrial Fibrillation Registry(CAFR)trial

作　　者：孙丽杰[1] 杜昕[2] 刘书旺[1] 何榕[1] 曾辉[1] 孙超[1] 李蕾[1] 张媛[1] 马长生[2] 高炜[1] Sun Lijie;Du Xin;Liu Shuwang;He Rong;Zeng Hui;Sun Chao;Li Lei;Zhang Yuanl;Ma Changsheng;Gao Wei(Department of Cardiology and Institute of Vascular Medicine,Peking University Third Hospital,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,Ministry of Health,Key Laboratory of Molecular Cardiovascular Science,Ministry of Education.Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191;department of Cardiology,Beijing Anzhen Hospital of the Capital University of Medical Sciences,Beijing 100029,China)

机构地区：[1]北京大学第三医院心内科卫生部心血管分子生物学与调节肽重点实验室分子心血管学教育部重点实验室,100191 [2]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华心血管病杂志》2020年第9期740-747,共8页Chinese Journal of Cardiology

基　　金：北京市科技计划项目(D111100003011001)。

摘　　要：目的探讨心房颤动(房颤)患者口服抗心律失常药物(AAD)的治疗情况及其相关影响因素,并且依据房颤管理指南分析处方的合理性。方法收集2011年8月至2016年8月中国房颤注册研究中18014例房颤患者的病历资料,按基线或随访中是否应用AAD,分为AAD组7788例(43.23%)和非AAD组10226例(56.77%),并对在AAD组中占绝大多数的胺碘酮4129例(53.02%)和普罗帕酮3211例(41.23%)进行亚组分析,采用随机森林回归法探讨AAD应用的相关影响因素,并依据房颤管理指南分析用药合理性。结果纳入的18014例房颤患者中,男性10895例(60.48%),≥75岁的老年患者4081例(22.65%)。与非AAD组相比,AAD组≥75岁[13.74%(1070/7788)比29.44%(3011/10226)],持续性房颤[28.90%(2250/7788)比45.80%(4683/10226)],合并心力衰竭[8.29%(646/7788)比21.95%(2245/10226)],卒中/TIA[12.15%(946/7788)比19.95%(2040/10226)],肾功能异常[16.36%(1274/7788)比29.37%(3003/10226)],血栓栓塞风险为高危[60.17%(4748/7788)比76.40%(7813/10226)]的患者比例较低(P均<0.001)。多因素分析结果显示,三级医院(OR=3.72,95%CI:3.17~4.37)的患者更倾向于应用AAD,老年(OR=0.47,95%CI:0.39~0.55)、持续性房颤(OR=0.66,95%CI:0.60~0.72)、以及合并心力衰竭(OR=0.54,95%CI:0.47~0.63)、卒中和/或短暂性脑缺血发作(OR=0.77,95%CI:0.68~0.87)、肾功能异常(OR=0.75,95%CI:0.59~0.95)及血栓栓塞风险为高危(OR=0.70,95%CI:0.58~0.84)的患者更倾向于不应用AAD,P均<0.05。胺碘酮和普罗帕酮是最常用的AAD,分别占AAD组的53.02%(4129/7788)和41.23%(3211/7788)。多因素分析显示,持续性房颤(OR=4.57,95%CI:3.94~5.29)、合并冠心病(OR=4.14,95%CI:3.03~5.64)、心力衰竭(OR=2.07,95%CI:1.48~2.89)、非缺血性心肌病(OR=4.84,95%CI:2.41~9.73)的房颤患者更倾向于应用胺碘酮,左心室射血分数正常(OR=0.31,95%CI:0.15~0.65)、血栓栓塞风险为低危(OR=0.78,95%CI:0.63~0.97)的患者更倾向于应用普罗帕酮,P均<0.001。不遵循指南建议的AAD治疗的Objective To explore the practice patterns and the related factors of oral antiarrhythmic drug(AAD)treatment in Chinese patients with atrial fibrillation(AF),and to evaluate the compliance of AAD application to atrial fibrillation management guidelines.Methods From August 2011 to August 2016,medical records from 18014 patients with AF were analyzed based on data from the Chinese Atrial Fibrillation Registry trial.Patients were divided into AAD group(7788 cases,43.23%)and non-AAD group(10226 cases,56.77%)according to whether AAD was used at baseline or at the time of first use during follow-up.Amiodarone(4129 cases,53.02%)and propafenone(3211 cases,41.23%)were the mostly prescribed AAD and subgroup analysis was performed accordingly.Medical records were analyzed by random forest regression to evaluate the use of AAD and related factors in patients with AF,and the rationality of AAD was analyzed according to the guidelines for the management of atrial fibrillation.Result A total of 18014 patients were included in this study,of which 60.48%(10895/18014)were male patients,22.65%(4081/18014)were elderly patients(275 years old),there were 7788 patients(43.23%)in AAD group,and 10226 patients(56.77%)in non-AAD group.Compared with the non-AAD group,the elderly patients(375 years old,13.74%(1070/7788)vs.29.44%(3011/10226)),persistent AF(28.95%(2250/7788)45.80%(4683/10226)),heart failure(8.29%(646/7788)vs.21.95%(2245/10226)),stroke and(or)TIA(12.15%(946/7788)vs.19.95%(2040/10226)),renal dysfunction(16.36%(1274/7788)vs.29.37%(3003/10226)),and high thromboembolism risk<(60.17%(4748/7788)vs.76.40%(7813/10226))were less prevalent in the AAD subgroup(P<0.001).Multivariate analysis showed that patients in tertiary hospitals(OR=3.72,95%CI 3.17-4.37)were more likely to use AAD,elderly patients(≥75 years old,0R=0.47,95%CI 0.39-0.55),persistent atrial firillation(0R=0.66,95%CI 0.60-0.72),and patients with heart failure(OR=0.54,95%CI 0.47-0.63),stroke and(or)TIA(OR=0.77,95%CI 0.68-0.87),renal dysfunction(OR=0.75,95%CI 0.59--0.95)and

关 键 词：心房颤动 抗心律失常药 应用实践 依从性 

分 类 号：R541.75[医药卫生—心血管疾病]