2001-2015年中国非ST段抬高心肌梗死住院患者心肌标志物检测的变化趋势  

Trends in Cardiac Biomarkers Analysis in Hospitals and Patients with Non-ST-elevation Myocardial Infarction in China from 2001 to 2015

作　　者：王思铭 张丽华 白雪珂 王斌 季润青 胡丹丽 李静[1] WANG Si-ming;ZHANG Li-hua;BAI Xue-ke;WANG Bin;JI Run-qing;HU Dan-li;LI Jing(National Clinical Research Center for Cardiovascular Diseases,NHC Key Laboratory of Clinical Research for Cardiovascular Medications,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,National Center for Cardiovascular Diseases,Beijing 100037,China)

机构地区：[1]国家心血管病中心,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国家卫生健康委员会心血管药物临床研究重点实验室,心血管疾病国家重点实验室,北京市100037

出　　处：《中国分子心脏病学杂志》2020年第5期3527-3530,共4页Molecular Cardiology of China

基　　金：国家重点研发计划项目(2018YFC1312400,2018YFC1312401);中国医学科学院医学与健康科技创新工程(2016-I2M-2-004);卫生公益性行业科研专项“冠心病医疗结果评价研究和临床转化研究”(201202025);高等学校学科创新引智计划(B16005)。

摘　　要：目的评价2001-2015年间心肌标志物在我国非ST段抬高心肌梗死(NSTEMI)住院患者中的检测应用情况及其变化趋势。方法通过两阶段随机抽样获得2001、2006、2011和2015年具有全国代表性的急性心肌梗死住院患者样本,集中进行病历资料信息提取,选取其中的NSTEMI患者,分析各家医院的心肌标志物(肌钙蛋白、肌酸激酶同工酶)检测开展情况和NSTEMI患者心肌标志物检测率随时间变化的趋势,以及NSTEMI患者心肌标志物检测率在每家医院的分布情况。结果共计156家医院的5289份NSTEMI住院病历被纳入本研究。2001、2006、2011和2015年开展心肌标志物检测(肌钙蛋白或肌酸激酶同工酶)的医院比例分别为77.4%、92.2%、97.8%和100%(趋势P值<0.001),其中开展肌钙蛋白检测的医院比例分别为35.5%、70.9%、85.3%、97.2%(趋势P值<0.001)。研究期间NSTEMI住院患者中肌钙蛋白的检测率显著增加,2001、2006、2011、2015年分别为20.5%、54.1%、67.7%、86.4%(趋势P值<0.001)。2015年,NSTEMI患者中仍有9.4%未检测心肌标志物;在具备肌钙蛋白检测能力的医院中,17%的医院NSTEMI患者检测率不足80%。结论2001~2015年,心肌标志物在我国NSTEMI住院患者中逐渐得到广泛应用,但肌钙蛋白检测的开展和应用仍存在改善空间。Objective To describe the trends in the availability of caidiac biomarkers testing in Chinese hospitals and trends of its application in patients with Non-ST-elevation myocardial infarction(NSTEMI)from 2001 to 2015.Methods We obtained nationally representative samples of Chinese patients hospitalized for AMI via a two-stage random sampling approach in 2001,2006,2011,and 2015.The patients with discharge diagnosis of NSTEMI were included in this study.We analyzed the temporal trends in the hospital capability and utilization rates of cardiac biomarkers analysis(troponin or CK-MB)among patients with NSTEMI,as well as the variations in utilization across hospitals with the capability of the biomarkers analysis.Results A total of 5289 NSTEMI patients from 156 hospitals in China were enrolled in this study.The proportion of hospitals with the capability of biomarkers analysis(troponin or CK-MB)was 77.4%,92.2%,97.8%and 100%in 2001,2006,2011,2015,respectively(P for trend<0.001),and the proportion of hospitals with the capability of troponin analysis was 35.5%,70.9%,85.3%and 97.2%(P for trend<0.0001).The rates of troponin analysis among patients with NSTEMI increased significantly over years(20.5%,54.1%,67.7%and 86.4%;P for trend<0.001).In 2015,9.4%of NSTEMI patients had no cardiac biomarkers analyzed,and there was still 17%of hospitals had a useof troponin analysis in NSTEMI patients lower than 80%although these hospitals had the capability of analysis.Conclusion From 2001 to 2015,cardiac biomarker analysis for NSTEMI patients is gradually extensively used in China.It still needs improvement in application of troponin analysis.

关 键 词：非ST段抬高心肌梗死 心肌标志物 肌钙蛋白 

分 类 号：R542.22[医药卫生—心血管疾病]