高危冠心病患者血管紧张素转换酶抑制剂类药物应用现况调查

ACEI/ARB use among high risk patients with coronary heart disease in China： a cross-sectional study

目的了解国内部分医院高危冠心病患者血管紧张素转换酶抑NN／血管紧张素Ⅱ受体拮抗剂（ACEI／ARB）类药物的使用现状，分析影响药物使用的相关因素。方法分别于2007年及2009年在14个城市的51家医院进行横断面调查，对符合条件的冠心病患者，利用电子问卷采集基线数据，对ACEI／ARB类冠心病二级预防药物的使用情况进行统计描述和分析。结果在13078例均应使用ACEI／ARB类药物的冠心病患者中，服用ACEI／ARB类药物的比例仅为45．8％，且病史超过1年的患者服药的比例明显下降。即使是合并糖尿病或高血压的患者服药比例也仅分别为46．1％和56．3％。多元logistic回归分析结果显示性别、合并心肌梗死或高血压病史、实施经皮冠状动脉介入治疗及病程长短是影响ACEI／ARB类药物使用的因素。各种ACEI／ARB类药物中，卡托普利使用最为广泛。结论目前国内冠心病患者ACEI／ARB类药物的使用状况存在明显不足，如何将循证医学证据与临床实践有机结合，让尽可能多的患者从中受益，仍是临床工作者及卫生决策部门面临的重大问题。

Objective This study investigated current use of ACEI/ARB among high risk patients with coronary heart disease （CHD） in China and factors affecting ACEI/ARB use in these patients. Methods This cross-sectional survey was performed between June to December 2007 and May to November 2009 in 51 hospitals from 14 cities. The characteristics of patients with established CHD were collected by electronic questionnaire. Results Only 45.8% high risk CHD patients were taking ACEI/ARB and the ACEI/ARB medication decreased significantly with time after initial CHD diagnosis. ACEI/ARB was taken in 46. 1% CHD patients complicated with diabetes mellitus and in 56. 3% CHD patients complicated with hypertension. Logistic regression analysis showed that eomorbid hypertension was the strongest factor associated with ACEI/ARB use. In addition, male gender, history of myocardial infarction （MI） , PCI and the time after initial CHD diagnosis were independent factors affecting the use of ACEI/ARB. Captopril was the most commonly prescribed ACEI in this cohort. Conclusion ACEI/ARB is underused in secondary prevention among high risk CHD patients in China. It remains a major challenge for healthcare professionals and policy makers to make efforts on narrowing the gap between evidence and practice.