慢性收缩性心力衰竭患者药物治疗情况调查及相关因素分析

Investigation on the prevalence and related factors of medicinal therapy in patients with chronic systolic heart failure

目的分析湖北省慢性收缩性心力衰竭（心衰）患者药物治疗分布及其影响因素。方法回顾性调查和分析2000--2010年湖北省8市12家三级甲等医院心衰住院患者资料，根据年龄、性别和随访结果分组，分析不同组间药物治疗种类和药费的分布差异。对药物治疗年费用进行log10对数转换。结果（1）共16681例心衰患者纳入研究，随访期间有6453例死亡。死亡组药物治疗年费用低于存活组（3．19±0．65vs3．32±0．57，P〈O．01）。（2）血管紧张素受体阻滞剂使用率随年龄增加而增加；而地高辛、利尿剂、p受体阻滞剂、血管紧张素转化酶抑制剂使用率随年龄增加呈倒“U”形分布。不同年龄组药物治疗存在性别差异。（3）随着患者年龄增加药物治疗费用有增加趋势（〈30、30～、40～、50～、60～和70～79岁组分别为2．96±0．70、3．09±0．62、3．15±0．58、3．30±0．59、3．25±0．58和3．35±0．60，P〈0．01），而年龄≥80岁组减低至50～岁组水平。男性患者药物治疗费的分布与全部患者水平相似，而女性患者在〈30、30～和40～岁组间无差异，在其他年龄组的分布与全部患者水平相似。结论湖北省心衰患者药物治疗有待改善，药物治疗受年龄、性别影响，其中女性患者药物治疗情况较男性差。

Objective To investigate the prevalence and related factors of medicinal therapy in patients with chronic systolic heart failure （CSHF）. Methods Data on in-hospital patients with CSHF were studied from 12 hospitals in Hubei province, in 2000 and 2010. Differences on gender and age were calculated and Multivariate Cox regression analysis was performed to determinate the independent risk factors of all-cause mortality. Results （1） 16 681 patients were enrolled in this study. Among which, 6453 died during the 5.82 ± 1.63 years of follow-up. The annual medical expenditure was larger in the survival group than in the dead ones （3.19± 0.65 vs. 3.32 ± 0.57, P〈 0.01）. （2）The prevalence of Angiotensin I/ receptor blocker increased along with age which accounted as 7.73% ,7.35%, 12.26%, 14.29%, 17.19%, 19.87% and 20.49% ,respectively, in the 〈30, 30-39, 40-49, 50-59, 60-69, 70-79 and ≥80-year groups. The distribution of digitalis, diuretics, 13-receptor blocker, Angiorensinconverting enzyke inhibitors showed inversed U shape. （3）The annual medical expenditure increased as patients got older, with age groups 〈30, 30-39, 40-49, 50-59, 60-69 and 70-79 years old as 2.96 ± 0.70, 3.09 ± 0.62, 3.15 ± 0.58, 3.30 ± 0.59 and 3.25 ± 0.58, respectively （P〈0.01）. It reduced to the same level as in the 50-59 year-old group. The distribution of annual medical expenditure showed similar pattern in males. However, the trends were only found in patients at 50-59, 60-69, 70-79 and ≥80 years-old groups in female. Conclusion More attention should be paid to medicinal therapy in patients with CSHF. Medicinal therapy shifted with age and gender, of which females had more adverse trend than in males.