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不同指南评价我国临床血脂异常达标率差别的研究 被引量:3

Differences in goal attainment in clinical management of dyslipidemia in China evaluated by different guidelines
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摘要 目的比较不同指南评价我国临床血脂异常达标率的差异,深入理解“中国成人血脂异常指南”(简称指南)与国内外相关指南的异同,促进指南更好地推广和应用。方法对“第二次中国临床血脂控制现状多中心协作研究”调查的2094例患者,分别依据2007年发布的指南与1997年的“血脂异常防治建议”(简称建议)、美国2004年更新的国家胆固醇教育计划成人治疗组第三次报告(简称ATPⅢ)计算LDL-C目标值的达标率。结果(1)依据建议、ATPⅢ和指南,总达标率分别为62%、34%和50%。(2)以指南为参照,全部极高危和40%高危患者被建议低估;低、中和高危患者各有40%以上被ATPⅢ高估。(3)指南与建议达标率差异中,90%由危险分层不同所致;ATPⅢ与指南达标率差异中,约30%由危险分层不同所致,70%由治疗目标值不同所致。结论应用不同指南为依据,达标率差异明显。指南较建议危险分层更加积极,较ATPⅢ简单实用。指南更适合在我国人群使用,应大力推广。 Objective To better understand the similarities and disparities between the newly issued Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults (CG) and exist relevant guidelines by comparing the actual effect on assessment of current clinical management of dyslipidemia in China, in order to promote the use of CG in clinical practice. Methods Study participants included 2094 patients from the Second Muhi-center Survey of Dyslipidemia Management in China. The goal attainment rate was defined as the proportion of participants who achieved their target low-density lipoprotein cholesterol (LDL-C) levels specified by CG, the Chinese Expert Recommendations on Prevention and Treatment of Dyslipidemia (CR), the updated Adult Treatment Panel m of the National Cholesterol Education Program (ATP Ⅲ ), respectively. Results (1)The overall goal attainment rates were 62%, 34% and 50% according to CR, ATP Ⅲ and CG, respectively. (2) With reference to the CG risk stratifications, the risk of nearly 40 % of high risk patients and all very high risk patients were underestimated by CR, whereas the risk of more than 40% of patients in any risk groups were overestimated by ATP Ⅲ. ( 3 ) The disparities in risk stratifications accounted for 90% of the difference in overall goal attainment rate ( 12% ) between CR and CG, while the disparities in the risk stratifications and that in LDL-C target levels were responsible for 29% and 71% of the difference ( 16% ) , respectively, between ATP Ⅲ and CG. Conclusions There were significant differences in goal attainment rates assessed by different clinical practice guidelines. CG is more aggressive in risk stratification than CR but simpler and easier to use than ATP m, and hence more appropriate to Chinese patients and should be widely promoted in China.
出处 《中华心血管病杂志》 CAS CSCD 北大核心 2009年第4期363-368,共6页 Chinese Journal of Cardiology
关键词 高脂血症 降脂药物 指南 心血管病危险评估 Dyslipidemia Lipid lowering drugs Guidelines Cardiovascular risk assessment
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