中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2012年
2期
107-111
,共5页
宋波%杨光%高远%卢甲盟%谈颂%李硕%常思远%许予明
宋波%楊光%高遠%盧甲盟%談頌%李碩%常思遠%許予明
송파%양광%고원%로갑맹%담송%리석%상사원%허여명
卒中%脑缺血发作,短暂性%羟甲基戊二酰基CoA还原酶抑制剂%病人依从
卒中%腦缺血髮作,短暫性%羥甲基戊二酰基CoA還原酶抑製劑%病人依從
졸중%뇌결혈발작,단잠성%간갑기무이선기CoA환원매억제제%병인의종
Stroke%Ischemic attack,transient%Hydroxymethylglutaryl-CoA reductase inhibitors%Patient compliance
目的 了解他汀类药物在缺血性卒中和TIA二级预防的不同危险因素分层中的应用现状,分析影响他汀类药物依从性的因素.方法 从2009年4月至2010年1月前瞻性登记在郑州大学第一附属医院神经内科连续入院的缺血性卒中和TIA患者,收集其临床特征及可能影响他汀类药物依从性的因素,随访发病后3个月时他汀类药物的应用情况,使用多元Logistic回归进行统计学分析.结果 共纳入缺血性卒中和TIA患者369例.住院期间有52.8％ (195/369)的患者应用他汀类药物.高危组、极高危Ⅱ组及极高危Ⅰ组他汀类药物应用的指南符合率分别为25.0％ (16/64),44.1％ (30/68)和71.4％(135/189),Logistic回归分析发现住院期间使用他汀类药物与糖尿病病史(P =0.032,OR=1.789,95％ CI 1.052～3.043)及颈动脉易损斑块的存在相关(P=0.000,OR=5.308,95％ CI3.340～8.434).3个月时他汀类药物总体应用率为22.3％(81/363),明显低于住院期间他汀类药物的应用率(P=0.000).3个月时高危组、极高危Ⅱ组及极高危Ⅰ组他汀类药物应用的指南符合率分别为9.7％ (6/62),25.8％ (17/66)和29.4％( 55/187).Logistic回归分析发现3个月随访时他汀类药物依从性好与出院医嘱相关(P =0.000,OR=34.852,95％ CI14.673 ～ 175.452).结论 他汀类药物在缺血性卒中和TIA二级预防中的依从性差,与指南存在差距；出院医嘱是二级预防中他汀类药物依从性好的促进因素.
目的 瞭解他汀類藥物在缺血性卒中和TIA二級預防的不同危險因素分層中的應用現狀,分析影響他汀類藥物依從性的因素.方法 從2009年4月至2010年1月前瞻性登記在鄭州大學第一附屬醫院神經內科連續入院的缺血性卒中和TIA患者,收集其臨床特徵及可能影響他汀類藥物依從性的因素,隨訪髮病後3箇月時他汀類藥物的應用情況,使用多元Logistic迴歸進行統計學分析.結果 共納入缺血性卒中和TIA患者369例.住院期間有52.8％ (195/369)的患者應用他汀類藥物.高危組、極高危Ⅱ組及極高危Ⅰ組他汀類藥物應用的指南符閤率分彆為25.0％ (16/64),44.1％ (30/68)和71.4％(135/189),Logistic迴歸分析髮現住院期間使用他汀類藥物與糖尿病病史(P =0.032,OR=1.789,95％ CI 1.052～3.043)及頸動脈易損斑塊的存在相關(P=0.000,OR=5.308,95％ CI3.340～8.434).3箇月時他汀類藥物總體應用率為22.3％(81/363),明顯低于住院期間他汀類藥物的應用率(P=0.000).3箇月時高危組、極高危Ⅱ組及極高危Ⅰ組他汀類藥物應用的指南符閤率分彆為9.7％ (6/62),25.8％ (17/66)和29.4％( 55/187).Logistic迴歸分析髮現3箇月隨訪時他汀類藥物依從性好與齣院醫囑相關(P =0.000,OR=34.852,95％ CI14.673 ～ 175.452).結論 他汀類藥物在缺血性卒中和TIA二級預防中的依從性差,與指南存在差距；齣院醫囑是二級預防中他汀類藥物依從性好的促進因素.
목적 료해타정류약물재결혈성졸중화TIA이급예방적불동위험인소분층중적응용현상,분석영향타정류약물의종성적인소.방법 종2009년4월지2010년1월전첨성등기재정주대학제일부속의원신경내과련속입원적결혈성졸중화TIA환자,수집기림상특정급가능영향타정류약물의종성적인소,수방발병후3개월시타정류약물적응용정황,사용다원Logistic회귀진행통계학분석.결과 공납입결혈성졸중화TIA환자369례.주원기간유52.8％ (195/369)적환자응용타정류약물.고위조、겁고위Ⅱ조급겁고위Ⅰ조타정류약물응용적지남부합솔분별위25.0％ (16/64),44.1％ (30/68)화71.4％(135/189),Logistic회귀분석발현주원기간사용타정류약물여당뇨병병사(P =0.032,OR=1.789,95％ CI 1.052～3.043)급경동맥역손반괴적존재상관(P=0.000,OR=5.308,95％ CI3.340～8.434).3개월시타정류약물총체응용솔위22.3％(81/363),명현저우주원기간타정류약물적응용솔(P=0.000).3개월시고위조、겁고위Ⅱ조급겁고위Ⅰ조타정류약물응용적지남부합솔분별위9.7％ (6/62),25.8％ (17/66)화29.4％( 55/187).Logistic회귀분석발현3개월수방시타정류약물의종성호여출원의촉상관(P =0.000,OR=34.852,95％ CI14.673 ～ 175.452).결론 타정류약물재결혈성졸중화TIA이급예방중적의종성차,여지남존재차거；출원의촉시이급예방중타정류약물의종성호적촉진인소.
Objective To investigate the application of statins in secondary prevention of ischemic stroke and transient ischemic attacks (TIA) in different risk groups,and to identify the factors influencing the compliance of statins. Methods Data were prospectively collected on consecutively encountered ischemic stroke or TIA patients admitted to the First Affiliated Hospital of Zhengzhou University from April 2009 to January 2010.All clinical characteristics and possible factors influencing the compliance of statins were collected; the application of statins was investigated at 3-month follow-up.The multivariate Logistic regression analysis was used for the analysis of influence factors of the compliance of statins.Results All 369 patients were collected,52.8％ of cases were prescribed statins for therapy during hospitalization.The application rate of statins in accordance with guidelines in high-risk group,extremely high-risk Ⅱ group and extremely high-risk Ⅰ group was 25.0％ (16/64),44.1％ (30/68) and 71.4％ (135/189),respectively. Logistic regression analysis showed that the statins application during hospitalization was associated with diabetes history ( P =0.032,OR =1.789,95％ CI 1.052-3.043 ) and the presence of carotid vulnerable plaques(P =0.000,OR =5.308,95％ CI 3.340-8.434).The general application rate of statins was 22.3％ (81/363),which was significantly lower than that during hospitalization. The application rate of statins in accordance with guidelines in high-risk group,extremely high-risk Ⅱ group and extremely high-risk Ⅰ group was 9.7％ ( 6/62 ),25.8％ (17/66) and 29.4％ (55/187) respectively.Logistic regression analysis showed that good compliance of statins was associated with discharge instructions on statins application ( P =0.000,OR =34.852,95％ CI 14.673-175.452 ). Conclusions The compliance of statins in secondary prevention of ischemic stroke and TIA is poor,and there is still a large gap between clinical practice and guidelines; Discharge instructions on statins application increase the compliance of statins.
