2001~2011年中西部城市急性心肌梗死患者rACEI/ARB的应用及影响因素

摘要

目的 了解中国中西部城市急性心肌梗死(AMI)患者血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂(ACEI/ARB)的使用情况,并探讨其影响因素.方法 采用两阶段随机抽样抽取中西部城市31家医院2001年、2006年、2011年的AMI患者病历,收集和提取相关资料,分析ACEI/ARB的使用情况以及使用的影响因素.结果 共入选3044例患者,其中中国指南Ⅰ类推荐2951例,指南Ⅱa类推荐93例.2001年、2006年和2011年,指南Ⅰ类推荐患者ACEI/ARB使用情况为240(71.43%)、598(73.19%)、1230(68.41%);指南Ⅱa类推荐患者为4(57.14%)、5(62.50%)和37(47.44%).在3个研究年份中,ACEI使用率均显著高于ARB(71.13%vs.0.60%;71.36%vs.2.57%;57.23%vs.11.79%),差异有统计学意义(P均<0.05).多因素分析显示,与对应组相比,合并高血压(OR=2.37,95%CI:1.89~2.98)、糖尿病(OR=1.32,95%CI:1.02~1.70),心力衰竭病史(OR=1.65,95%CI:1.29~2.12),年龄≥75岁(OR=1.49,95%CI:1.14~1.95),入院时收缩压≥140 mmHg(OR=1.94,95%CI:1.55~2.43),肾小球滤过率未测量(OR=4.10,95%CI:2.66~6.33)的患者更倾向于使用ACEI/ARB.女性(OR=0.77,95%CI:0.63~0.94)、非前壁ST段抬高型心肌梗死(OR=0.69,95%CI:0.59~0.82)、左室射血分数未测量(OR=0.47,95%CI:0.36~0.61)、有中风史(OR=0.73,95%CI:0.57~0.95)、合并慢性肾功能不全(OR=0.44,95%CI:0.20~0.95)的患者较少使用ACEI/ARB.结论 中西部城市AMI患者中,指南I类推荐的患者约1/3住院期间未接受ACEI/ARB类药物治疗,且10年间该类药物的应用无明显改善.基于指南强烈推荐,AMI患者需增加ACEI/ARB类药物的应用.%Objective To get to know the application of angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy, and discuss the influence factors on it in patients with acute myocardial infarction (AMI) in the central and western cities in China.Methods The medical records of AMI patients were chosen for collecting and extracting relevant data by using 2-stage random sampling method from 31 hospitals in the central and western in Chin in 2001, 2006 and 2011, and the application of ACEI/ARB therapy and influence factors on it were analyzed.Results There totally 3044 patients chosen, and among them 2951 had indications of class I in the Guideline for Diagnosis and Treatment of Acute ST-Segment Elevation Myocardial Infarction (class I patients) and 93 had indications of class IIa in the Guideline (class IIa patients). There were 240 (71.43%) class I patients treated with ACEI/ARB therapy in 2001, 598 (73.19%) in 2006 and 1230 (68.41%) in 2011. There were 4 (57.14%) class IIa patients treated with ACEI/ARB therapy in 2001, 5 (62.50%) in 2006 and 37 (47.44%) in 2011. The usage rate of ACEI therapy was significantly higher than that of ARB therapy in 2001 (71.13%vs. 0.60%), 2006 (71.36%vs. 2.57%) and 2011 (57.23%vs. 11.79%, allP<0.05). The multi-factor analysis showed that the patients with complicated hypertension (OR=2.37, 95%CI: 1.89~2.98), diabetes (OR=1.32, 95%CI: 1.02~1.70), history of heart failure (OR=1.65, 95%CI: 1.29~2.12), age≥75岁 (OR=1.49, 95%CI: 1.14~1.95), hospital-admitted systolic blood pressure≥140 mmHg (OR=1.94, 95%CI: 1.55~2.43) and undetected glomerular filtration rate (GFR, OR=4.10, 95%CI: 2.66~6.33) were more inclined to receive ACEI/ARB therapy. The female patients (OR=0.77, 95%CI: 0.63~0.94), and the patients with non-STEMI (OR=0.69, 95%CI: 0.59~0.82), undetected left ventricular ejection fraction (OR=0.47, 95%CI: 0.36~0.61), history of stroke (OR=0.73, 95%CI: 0.57~0.95) and complicated chronic renal insufficiency (OR=0.44, 95%CI: 0.20~0.95) received fewer ACEI/ARB therapy.Conclusion There are about 1/3 class I patients without receiving ACEI/ARB therapy, and the application of it has not improved for 10 y in AMI patients in the central and western cities in China. Based on the highly recommendation of China guideline, the application of ACEI/ARB therapy should be promoted in AMI patients.