2001-2011年浙江省急性心肌梗死患者ACEI/ARB应用情况及其影响因素

摘要
图/表
参考文献
相关文章 (3)

全文: PDF (1406 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：了解浙江省急性心肌梗死（AMI）患者中血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）的使用情况，并探讨其影响因素。方法：收集浙江省8家协作医院2001、2006和2011年AMI患者的临床资料，分析ACEI/ARB的使用情况，并采用二元logistic回归方法探讨其使用的影响因素。结果：共入选604例患者，其中中国指南I类推荐患者590例，IIa类推荐患者14例。指南I类推荐患者ACEI/ARB使用率在2001、2006和2011年分别为73.26%、72.16%和60.65%（P=0.005），指南IIa类推荐患者为0、50.00%和45.45%（P=0.513）。在3个研究年份中，指南I类推荐患者ACEIs使用率均显著高于ARBs。Logistic回归分析显示，指南I类推荐患者中，与参照组相比合并高血压（OR=3.8，95%CI=2.5～5.9）、eGFR未测量（OR=15.7，95%CI=6.9～35.6）患者更倾向于使用ACEI/ARB，相反，eGFR＜60 mL/（min·1.73 m2）（OR=0.3，95%CI=0.2～0.5）、LVEF值未测量（OR=0.3，95%CI=0.2～0.5）患者较少使用ACEI/ARB。结论：2001-2011年浙江省AMI患者指南I类推荐ACEI/ARB使用率无明显改善，需进一步规范遵循指南，改善医疗质量。

	服务
	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	葛卫力
	米亚非
	江建军
	薛迎生
	王斌
	李涛

关键词 ：急性心肌梗死, 血管紧张素转换酶抑制剂, 血管紧张素受体阻滞剂

Abstract：Objective: To evaluate patterns of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) therapy in patients with acute myocardial infarction (AMI) in Zhejiang Province from 2001 to 2011, and to identify factors affecting the use of ACEI/ARB. Methods: Clinical information of AMI patients from 8 hospitals in Zhejiang Province were collected in 2001, 2006 and 2011, and patterns of ACEI/ARB therapy by year were analyzed. Binary logistic regression analysis was used to identify factors related to the use of ACEI/ARB. Results: A total of 604 patients were included, of whom 590 were eligible for Class I indication by Chinese guidelines and 14 were eligible for Class IIa indication. From 2001 to 2011, the use of ACEI/ARB in patients with Class I indication and Class IIa indication were 73.26%, 72.16%, 60.65% (P=0.005) and 0, 50.00%, 45.45% (P=0.513) respectively. In the three specific years to be studied, the use rate of ACEIs in patients with Class I indication was noticeably higher than that of ARBs. Binary logistic regression analysis showed that patients with Class I indication complicated with hypertension (OR=3.8, 95%CI=2.5-5.9), eGFR unmeasure (OR=15.7, 95%CI=6.9-35.6) were more likely to be treated with ACEI/ARB, and patients with LVEF value unmeasured (OR=0.3, 95%CI=0.2-0.5), eGFR< 60 mL/(min·1.73 m2) (OR=0.3, 95%CI=0.2-0.5) were less likely to be treated with ACEI/ARB. Conclusion: There’s little improvement in the use rate of ACEI/ARB therapy during hospitalization in AMI patients with Class I indication in Zhejiang Province from 2001 to 2011. Further efforts should be devoted to enhancing the compliance of therapy with current practice guidelines to improve the medical care.

Key words： acute myocardial infarction angiotensin-converting enzyme inhibitors angiotensin receptor blockers

收稿日期: 2018-01-22

基金资助:卫生部卫生公益性行业科研专项（201202025）；浙江省医药卫生科技计划项目（2017KY164）；台州市科技计划A类项目（2013A32031）。

通讯作者: 米亚非，主任医师，Email：miyf@enzemed.com。

作者简介: 葛卫力（1981-），男，浙江临海人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I6/424

[1] 国家心血管病中心. 中国心血管病报告2015[M]. 北京: 中国大百科全书出版社, 2016.
[2] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南[J]. 中华心血管病杂志, 2015, 43(5): 380-393.
[3] ROFFI M, PATRONO C, COLLET J P, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2016, 37(3): 267-315.
[4] O’GARA P T, KUSHNER F G, ASCHEIM D D, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 2013, 127(4): e362-425.
[5] LI J, LI X, WANG Q, et al. ST-segment elevation myocardial infarction in China from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): A retrospective analysis of hospital data[J]. Lancet, 2015, 385 (9966): 441-451.
[6] DHARMARAJAN K, LI J, LI X, et al. The China Patient-Centered Evaluative Assessment of Cardiac Events (China PEACE) retrospective study of acute myocardial infarction: study design[J]. Circ Cardiovasc Qual Outcomes, 2013, 6 (6): 732-740.
[7] LIU J, MASOUDI F A, SPERTUS J A, et al. Patterns of use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers among patients with acute myocardial infarction in China from 2001 to 2011: China PEACE-Retrospective AMI Study[J]. J Am Heart Assoc, 2015, 4(2). Pii: e001343.
[8] 杨进刚, 许海燕, 高晓津, 等. 中国省、市和县级医院急性ST段抬高型心肌梗死住院患者再灌注治疗和二级预防用药分析[J]. 中国循环杂志, 2017, 32(1): 12-16.
[9] BLIN P, PHILIPPE F, BOUéE S, et al. Outcomes following acute hospitalised myocardial infarction in France: An insurance claims database analysis[J]. Int J Cardiol, 2016, 219: 387-393.
[10] HALVORSEN S, JORTVEIT J, HASVOLD P, et al. Initiation of and long-term adherence to secondary preventive drugs after acute myocardial infarction[J]. BMC Cardiovasc Disord, 2016, 16: 115.