脑卒中高危人群用药依从性及对预后影响的多中心前瞻性研究  

Medication adherence and its influence on the prognosis of individuals at high risk of stroke:a prospective multi-center study

作　　者：李洁[1] 张萍[1] 黄楷森[2] 陈洪[1] 卿婷 王淳[1] 易兴阳[1] LI Jie;ZHANG Ping;HUANG Kaisen;CHEN Hong;QING Ting;WANG Chun;YI Xingyang(Department of Neurology,People’s Hospital of Deyang City,Deyang,Sichuan 618000,P.R.China;Department of Cardiovascular Medicine,People’s Hospital of Deyang City,Deyang,Sichuan 618000,P.R.China)

机构地区：[1]德阳市人民医院神经内科,四川德阳618000 [2]德阳市人民医院心血管内科,四川德阳618000

出　　处：《华西医学》2022年第6期823-829,共7页West China Medical Journal

基　　金：四川省科技计划项目(2018JY0389);四川省卫生和计划生育委员会科研课题(17PJ084)。

摘　　要：目的探讨脑卒中高危人群高血压病、糖尿病、血脂异常用药依从性及影响因素,分析用药依从性对脑卒中高危人群预后的影响。方法采用统一的脑卒中高危人群筛查量表于2015年5月-9月对四川省8个社区16892名年龄≥40岁的居民进行面对面筛查,建立脑卒中高危人群数据库,通过结构化的随访表,记录高危人群对高血压病、糖尿病、血脂异常三大危险因素的治疗情况和治疗依从性,采用多因素logistic回归分析探讨高危人群随访期内用药依从性的影响因素,以及用药依从性对高危人群随访期内脑卒中发病的影响。结果共筛查出脑卒中高危人群2893例,筛查时高血压病、糖尿病、血脂异常治疗率分别为50.1%、49.2%、5.1%,中位随访时间为4.8年,随访期末时高血压病、糖尿病、血脂异常治疗率分别为24.8%、25.0%、7.9%,治疗依从率分别为27.8%、25.5%、18.1%。多因素logistic回归分析结果显示高中及以上文化程度[比值比(odds ratio,OR)=2.134,95%置信区间(confidence interval,CI)(1.098,4.147),P=0.025]、城镇居民医疗保险[OR=1.556,95%CI(1.086,2.230),P=0.016]及城镇职工医疗保险[OR=2.325,95%CI(1.362,3.967),P=0.002]、子女人数较少[OR=0.819,95%CI(0.719,0.933),P=0.003]、卒中家族史[OR=1.559,95%CI(1.066,2.282),P=0.022]与降压治疗依从性良好相关;城镇职工医疗保险与糖尿病患者降糖治疗依从性良好相关[OR=2.494,95%CI(1.173,5.300),P=0.018]。校正混杂因素后,高血压者未规律降压[OR=2.617,95%CI(1.414,4.842),P=0.002]、糖尿病者未规律降糖[OR=3.909,95%CI(2.394,6.380),P<0.001]、血脂异常者未规律降脂[OR=4.828,95%CI(2.581,9.033),P<0.001]均与随访期内脑梗死发病风险增高相关。血脂异常者规律降脂与随访期内脑出血发病风险增高独立相关[OR=4.371,95%CI(1.156,16.530),P=0.030]。结论四川省脑卒中高危人群高血压病、糖尿病、血脂异常患病率高,但治疗率低,治疗依从性差,治疗�Objective To investigate the medication adherence to antihypertensives,antidiabetics,and lipidlowering agents and its influence on the prognosis of individuals at high risk of stroke.Methods A total of 16892 residents aged 40 years or above in eight communities in Sichuan participated in a face-to-face study from May to September 2015.A database of a high-risk population of stroke in Sichuan province was established,and data were collected via using a standardized structured questionnaire by experienced investigators,including the treatment status and medication compliance of participants with hypertension,diabetes,or dyslipidemia during the follow-up period.Multiple logistic regression analyses were performed to explore the influencing factors of medication adherence and its influence on the prognosis of individuals at high risk of stroke.Results A total of 2893 participants at high risk of stroke were enrolled.The treatment rates of hypertension,diabetes,and dyslipidemia were 50.1%,49.2%,and 5.1%,respectively,when the high-risk individuals were identified.At the end of follow-up(with a median follow-up period of 4.8 years),the treatment rates of hypertension,diabetes,and dyslipidemia were 24.8%,25.0%,and 7.9%,respectively.Medication adherence to antihypertensives,antidiabetics,and lipid-lowering agents were 27.8%,25.5%,and 18.1%,respectively.Multiple logistic regression analyses showed that the education level of high school or above[odds ratio(OR)=2.134,95%confidence interval(CI)(1.098,4.147),P=0.025],medical insurance for urban residents[OR=1.556,95%CI(1.086,2.230),P=0.016]and urban employees[OR=2.325,95%CI(1.362,3.967),P=0.002],having fewer children[OR=0.819,95%CI(0.719,0.933),P=0.003],and family history of stroke[OR=1.559,95%CI(1.066,2.282),P=0.022]were associated with greater adherence to antihypertensives;medical insurance for urban employees was associated with greater adherence to antidiabetics[OR=2.494,95%CI(1.173,5.300),P=0.018].After adjusting for confounding factors,failure to regular use of antihyp

关 键 词：脑卒中 高危人群 用药依从性 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]