老年冠心病患者血压、血糖及血脂达标率的现况调查

A cross-sectional study on the treatment goals of blood pressure, serum lipids and blood glucose inelderly patients with coronary heart disease

目的探讨影响老年冠状动脉粥样硬化性心脏病（CHD）患者血压、血糖及血脂达标的相关因素。方法连续人选2006年6月至2007年1月，66家医院的心内科门诊被诊断为CHD的患者2420例（年龄均〉65岁，其中男1441例，占59．5％）进行横断面调查。结果老年CHD患者血压达标率为24．8％（599／2420），女性低于男性[213例（21．8％）比386例（26．8％），P〈0．01]；血脂达标率为36．5％（884／2420），女性明显低于男性[281例（28．7％）比603例（41．8％），P〈0．01]，且老年CHD患者的血脂达标率随着年龄的增加而升高（P〈0．05）；血糖达标率为61．0％（1476／2420）。进行二分类Logistic向前逐步回归分析显示影响血压达标的相关因素的比值比（OR）值分别为：女性1．245『95％可信区间（CI）：1．016—1．527]、高血压史2．889（95％CI：2．319—3．599）、利尿剂0．689（95％CI：0．538～0．883）、硝苯地平0．405（95％c，：0．170—0．964）；影响血脂达标的相关因素的OR值分别为：女性1．750（95％CI：1．252～2．445）、高血压病程10—20年3．988（95％CI：1．951—8．152）、高血压病程20～30年2．158（95％CI：1．075—4．333）、糖尿病史3．026（95％CI：1．986～4．610）、血脂异常史2．166（95％口：1．549～3．030）、治疗性生活方式改变（TLC）0．493（95％CI：0．302—0．805）；影响血糖达标的相关因素的OR值分别为：糖尿病史3．191（95％CI：2．259—4．507）、TLC0．690（95％CI：0．528～0．902）、利尿剂1．507（95％CI：1．150—1．975）、钙离子拮抗剂（CCB）0．718（95％c，：0．579～0．890）、口服降糖药0．477（95％CI：0．235～0．969）。结论我国老年CHD患者的血压、血脂和血糖达标率均较低，尤其是血压及血脂达标率亟待提高。老年女性CHD患者的血压及血脂达标率均显著低于男性。应针对影响我国老年CHD患者血压、血脂及血糖达标的相关因素，积极规范进行降压、调脂及降糖治疗，同时应加强对老年人群的综合管理，尤其需关注老年女性CHD患者。

Objective To investigate the current status of treatment goals for blood pressure, serum lipids and blood glucose in the elderly patients （ 〉 65 years old） with coronary heart disease （CHD） in China and to identify their associated factors. Methods In this cross-sectional survey, the CHD subjects aged 〉 65 years old were recruited from 66 hospitals in Beijing, Shanghai, Tianjin, Guangdong, Zhejiang and Xinjiang from June 2006 to January 2007. Results A total of 2420 participants, including 1441 males and 979 females. Their mean age was （ 73 ＋ 6 ） years. The targeted blood pressure was systolic blood pressure 〈 130 mm Hg（ 1 mm Hg =0. 133 kPa） and diastolic blood pressure 〈 80 mm Hg. And the success rate was 24. 8% （559/2420）. The blood pressure achievement rate among the females was 21.8%（213/979）. And it was lower than 26. 8% （386/1441） among the males （ P 〈 0. 01 ）. The serum lipids goal of achievement was LDL-C （ low density lipoprotein-cholesterol ） 〈 2. 6 mmol/L for the high-risk patients and LDL-C 〈 2. 07 mmol/L especially for the super-high-risk patients. The success rate for achieving the target LDL-C level was 36. 5% （884 cases）. The LDL-C achievement rate among the females was 28. 7% （281 cases）. And it was obviously lower than 41.8% （603 cases） among the males （P 〈 0. O1 ）. The success rate for achieving the target LDL-C level increased with aging （ P 〈 0. 05 ）. The blood glucose goal of achievement was FPG （fasting plasma glucose） 〉4.4 mmo//L and FPG 〈6. 1 mmol/L. The suecess rate for achieving the target blood glucose level was 61.0% （1476/2420）. Binary logistic regression analysis indicated that the independent risk factors of achieving the blood pressure target for the elderly CHD patients were female, history of hypertension, diuretics and nifedipine. The odds ratio （OR） of these risk factors were 1. 245 [95% confidence interval （CI） ： 1. 016 - 1. 527], 2. 889 （95% C[： 2. 319 -3. 599）, 0.689 （95% CI： 0.538-0. 883）, 0.405 （95% CI： 0. 170-0.964） respectively. The independent risk factors of achieving the serum lipids target for the elderly CHD patients were female, the duration of hypertension of 10 -20 years, the duration of hypertension of 20 -30 years, diabetic history or dyslipidemia and therapeutic lifestyle change （ TLC ）. The OR of these risk factors were 1. 750 （ 95% Cl： 1. 252 - 2. 445）, 3. 988 （95% CI： 1. 951 -8, 152）, 2. 158 （95% CI： 1. 075 -4. 333）, 3. 026 （95% CI： 1. 986 - 4. 610）, 2. 166 （95% CI： 1. 549 - 3. 030） and 0. 493 （95% CI： O. 302 - 0. 805） respectively. The independent risk factors of achieving the blood glucose target for the elderly CHD patients were diabetic history, TLC, diuretics, calcium channel blocker （CCB） and hypoglycemic drugs. The OR of these risk factors were 3. 191 （95%CI： 2. 259 -4.507）, 0.690 （95%CI： 0.528 -0.902）, 1.507 （95%C1： 1. 150 - 1. 975 ）, 0. 718 （95% CI： O. 579 - 0. 890） and 0. 477 （95% CI： O. 235 - 0. 969 ） respectively. Conclusion In the present survey, the achievement rates of blood pressure, serum ｜ipids and blood glucose are low in the elderly CHD patients, especially in females. There has been a huge gap between the treatment guidelines and clinical practices in China. We should carry out different strategies according to different conditions to enhance the health and life quality for the elderly CHD patients.