他汀类药物在中国极高危冠心病患者二级预防中的应用现况

Real world use of statins for secondary prevention in patients with high risk coronary heart disease in China

目的 通过了解中国内地31个省市门诊极高危冠心病患者调脂治疗状况,评价我国极高危冠心病患者二级预防重点措施的临床应用与指南的差距.方法 2006年在中国内地31个省市自治区选择32家三级医院和32家二级医院,每家医院从研究启动时点开始连续收集门诊极高危冠心病患者50例.采用访谈形式收集患者的信息,填写统一表格.结果 在2516例门诊极高危冠心病患者中,男性1746例,女性770例,年龄（65±10）岁.门诊极高危冠心病患者本次就诊前他汀类药物的服用率为[57.9%（1456/2516）],其中男性高于女性[60.5%（1056/1746）比51.9%（400/770）,P＜0.01],三级医院患者高于二级医院患者[65.0%（858/1320）比50.0%（598/1196）,P＜0.01].低密度脂蛋白胆固醇的达标率为29.8%（537/1803）,三级医院高于二级医院[32.2%（309/959）比27.0%（228/844）,P＜0.05],7个地区（华北、华东、华南、华中、东北、西南和西北）中,华中地区达标率最高[38.5%（77/200）],东北地区最低[18.5%（34/184）].本次就诊时,68.2%（1713/2511）的患者获得医生的他汀类药物处方,其中84.4%（1437/1703）处方为原研他汀类药物,75.9%（1256/1655）的他汀类药物处方剂量符合指南推荐的标准剂量.结论 我国内地门诊极高危冠心病患者低密度脂蛋白胆固醇控制状况与指南有一定差距,且不同级别医院、不同地区之间存在明显差异.

Objective To observe the real world statins use for secondary prevention in patients with high risk coronary heart disease （CHD） in China. Methods Sixty-four hospitals across 31 provinces of China including 32 secondary hospitals and 32 tertiary hospitals were selected for baseline survey. Fifty consecutive outpatients with established history of acute coronary syndrome were recruited in each hospital.Information of these patients including statins use was collected. Results A total of 2516 high risk CHD outpatients were involved in present report. Mean age of the patients was （65 ± 10） years and 69. 4%patients were male. Fifty-seven point nine percent patients were treated with a statin at the time of interview and recommended low-density lipoprotein-cholesterol （LDL-C） target was achieved in 29. 8% patients.Percent of statin use and achieving LDL-C goal was significantly higher in male outpatients than in female outpatients. Outpatients admitted in tertiary hospitals were more likely to have achieved their LDL-C targets than those admitted in secondary hospitals. Statin use was more often for patients in South China than patients in North China. The percentage reaching the optimal LDL-C treatment target was the highest in Central China （38. 5% ） and the lowest in Northeast China （18.5%）. At this interview, 68. 2% outpatients were prescribed statins and 24. 1% prescribed doses of statins were sub-minimal. Conclusion There was a gap between real world statin use and guideline recommendations for secondary prevention in high risk CHD patients in China.