CAJ | 학술논문

目的分析我国住院急性冠状动脉综合征患者多重危险因素的分布特点和指南推荐药物使用的现状及影响因素.方法为多中心横断面研究,全国22个省、市、自治区的34家协作医院参加.从2012年4月15日起,各协作医院连续入选符合标准的住院冠心病患者≥90例.资料完整用于此次分析的病例共3 253例.结果 (1)住院冠心病患者平均年龄男性小于女性(60.4岁比66.2岁,P＜0.01).近60％的患者＜65岁.男性有约1/3患者(＜55岁),女性有2/5患者(＜65岁)为早发冠心病病例.(2)高血压、高脂血症、吸烟和糖尿病4个主要危险因素中以合并高血压患病率最高,为68.4％.90％以上的患者合并有≥1项危险因素,其中约2/3的患者合并有≥2项危险因素.(3)指南推荐药物应用情况:阿司匹林使用率最高,达到了95.3％;其次为他汀类药物,为90.1％,最低的是血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB),为53.6％.多因素分析显示,与住院期间未接受经皮冠状动脉介入治疗(PCI)患者相比,接受PCI者ACEI或ARB和β受体阻滞剂使用率提高30％以上,他汀类药物的使用率提高50％以上,抗血小板药物的使用率提高了4～7倍.结论我国90％以上的住院冠心病患者合并有≥1个主要心血管病危险因素.指南推荐应用的药物仍有改善余地.应加强对未行PCI的冠心病患者指南推荐药物的应用.
목적 분석아국주원급성관상동맥종합정환자다중위험인소적분포특점화지남추천약물사용적현상급영향인소.방법 위다중심횡단면연구,전국22개성、시、자치구적34가협작의원삼가.종2012년4월15일기,각협작의원련속입선부합표준적주원관심병환자≥90례.자료완정용우차차분석적병례공3 253례.결과 (1)주원관심병환자평균년령남성소우녀성(60.4세비66.2세,P＜0.01).근60％적환자＜65세.남성유약1/3환자(＜55세),녀성유2/5환자(＜65세)위조발관심병병례.(2)고혈압、고지혈증、흡연화당뇨병4개주요위험인소중이합병고혈압환병솔최고,위68.4％.90％이상적환자합병유≥1항위험인소,기중약2/3적환자합병유≥2항위험인소.(3)지남추천약물응용정황:아사필림사용솔최고,체도료95.3％;기차위타정류약물,위90.1％,최저적시혈관긴장소전환매억제제(ACEI)혹혈관긴장소Ⅱ수체조체제(ARB),위53.6％.다인소분석현시,여주원기간미접수경피관상동맥개입치료(PCI)환자상비,접수PCI자ACEI혹ARB화β수체조체제사용솔제고30％이상,타정류약물적사용솔제고50％이상,항혈소판약물적사용솔제고료4～7배.결론 아국90％이상적주원관심병환자합병유≥1개주요심혈관병위험인소.지남추천응용적약물잉유개선여지.응가강대미행PCI적관심병환자지남추천약물적응용.
Objective To analyze the distribution of multiple risk factors for hospitalized patients with acute coronary syndromes (ACS) and explore the status and determinants of drug usage recommended by the guideline.Methods This was a multi-center cross-sectional study in 34 hospitals from 22 provinces in China.About ninety ACS patients were consecutively enrolled from each hospital since April 15,2012 according to a standard protocol.Totally,3 253 patients with complete data were analyzed in this study.Results (1) The average age of male patients with ACS was lower than that of female patients (60.4 years vs 66.2 years,P ＜0.01).Nearly 60％ of ACS patients were under the age of 65 years.Early onset of ACS accounted for one-third of male (＜ 55 years of age) and two-fifthes of female patients (＜ 65 years old).(2) Among the four ACS major risk factors (hypertension,hyperlipidemia,smoking and diabetes),hypertension was with the highest prevalence (68.4％).More than 90％ of ACS patients had at least one risk factor and about two-thirds of them had at least two.(3) As for the application of evidence-based drugs,the top one was aspirin with 95.3％ of ACS patients reseiving it.The second was statins (90.1％).Angiotensin converting enzyme inhibitors (ACEI) or angiotension Ⅱ receptor blocker(ARB) was the lowest (53.6％).Multivariable analysis indicated that,in contrast to that in ACS patients without percutaneous coronary intervention(PCI),the drug usage rates were increased by more than 30％ for ACEI or ARB and β receptor blockers,by more than 50％ for statins,and by 4-7 times for antiplatelet agents among ACS patients with PCI.Conclusions In China,more than 90％ of hospitalized patients with ACS carried at least one major risk factor.There is still room for improving in the application of drugs recommended by the guidelines,especially for ACS patients without PCI.