中国15省慢性稳定性心绞痛患者抗心绞痛治疗现状调查

Current status of medical therapy for chronic stable angina pectoris in China

目的描述中国慢性稳定性心绞痛患者抗心绞痛治疗的现状,比较不同级别医院的抗心绞痛药物使用情况,分析影像学检查和血运重建治疗对药物使用的影响。方法对2011年全国15个省298家二级和三级医院收治的慢性稳定性心绞痛患者药物治疗依从性调查问卷的填写,收集患者人口学信息、心绞痛临床表现和既往病史,记录稳定性心绞痛治疗药物的使用情况,包括药物种类及剂量。结果 5407例慢性稳定性心绞痛患者参加调查,5011份有效问卷纳入数据分析。男2859例（57.1%）,女2152例（42.9%）,平均年龄（67.6±11.5）岁。心绞痛病程在1年以内、1～5年和5年以上的患者分别占41.3%、39.1%和19.5%。合并高血压、高脂血症、糖尿病的患者分别占64.6%、59.9%和22.1%。在抗心绞痛药物中,β受体阻滞剂使用率为61.1%,钙拮抗剂为32.8%,硝酸酯类为56.8%。5011例患者中,76.5%使用治疗冠心病的中成药,81.4%服用阿司匹林,50.8%服用他汀类药物,41.6%服用ACEI类药物。抗心绞痛药物的使用：（1）医院级别分组比较：三甲医院β受体阻滞剂使用率（62.7%）明显高于三级乙等医院（58.7%）和二级医院（58.2%）,P=0.01;其他药物差异无统计学意义。（2）冠心病确诊依据和是否接受血运重建分组比较：1β受体阻滞剂使用率,接受血运重建组（71.4%）明显高于单纯影像学确诊组（63.9%）和非影像学确诊组（56.9%）,P〈0.01。2钙离子拮抗剂使用率,接受血运重建组（37.3%）明显高于单纯影像学确诊组（32.7%）和非影像学确诊组（31.4%）,P〈0.01。3硝酸酯类药物使用率三组均超过50%,差异无统计学意义。此外,抗血小板药物的使用,接受血运重建组（89.6%）高于单纯影像学确诊组（81.4%）和非影像学确诊组（78.0%）,P〈0.01。他汀类药物的使用,接受血运重建组（53.2%）和影像学确诊组（54.1%）与非影像学确诊组（49.0%）差异有统计学意义,P〈0.01。ACEI类药物的使用,接受血运重建组（51.4%）明显高于影像学确诊组（40.9%）和非影像学确诊组（38.7%）,P〈0.01。结论中国慢性稳定性心绞痛患者的抗心绞痛治疗,各级别医院的抗心绞痛药物的使用率均偏低。和非影像学确诊组相比,接受血运重建和（或）影像学确诊的患者药物使用更充分。

Objective To describe the current status of medical treatments for patients with chronic stable angina pectoris, and to compare the use of drugs in different levels of hospitals and to analyze the influence of radiographic and revascularization on drug use. Methods A standardized questionnaire, including information of characteristics,the clinical manifestation of angina pectoris,risk factors,complicated diseases and detailed medical therapy, was filled out by investigators for each patient. Results Totally 5407 questionnaires were collected from 298 hospitals in 15 provinces and 5011 intact records were used for final analysis.There were 2,859 males（57.1%） and 2,152 females（42.9%）, and their mean age was 67.6±11.5 years old. The disease duration less than 1 year, 1-5 years and 5 years accounted for 41.3%, 39.1% and 19.5%,respectively. Patients combined with hypertension, hyperlipidemia and diabetes accounted for 64.6%, 59.9% and 22.1%, respectively. The usage rate of β-blocker was 61.1%, calcium antagonists 32.8% and nitrates 56.8%. Among the 5011 cases, 76.5% were taking Chinese Traditional and Herbal Drugs, 81.4% aspirin, 50.8% statins and 41.6% ACEI. Comparision of the usage of anti-angina drugs：（1）Depending on the levels of hospitals, the usage rate of β-blocker was significantly higher in Third Level 1st Class hospitals（62.7%） than that in Third Level 2nd Class hospitals（58.7%） and Secondary Level hospitals（58.2%）, P=0.01. There was no significant difference in other anti-angina drugs.（2） Depending on the evidence to diagnosis of coronary artery disease and whether to accept revascularization： ① The usage rate of β-blocker in revascularization group（71.4%） was significantly higher than that in radiographic diagnosed group（63.9%） and non-radiographic diagnosed group（56.9%）, P〈0.01. ② The usage rate of calcium blockers in revascularization group（37.3%） was significantly higher than that in radiographic diagnosed group（32.7%） and non-radiographic diagnosed group（31.4%）, P〈0.01. ③ The usage rates of nitrates were all over 50% and there was no significant difference among the three groups. The usage rate of antiplatelet drugs in revascularization group（89.6%） was significantly higher than in merely radiographic diagnosed group（81.4%） and non-radiographic diagnosed group（78.0%）, P〈0.01.The usage rate of statin in revascularization group（53.2%） or and radiographic diagnosed group（54.1%） was significantly different from that in non-radiographic diagnosed group（49.0%）, P〈0.01. The usage rate of ACEI in revascularization group（51.4%） was significantly different from that in radiographic diagnosed group（40.9%） and non-radiographic diagnosed group（38.7%）, P〈0.01. Conclusion In general, the use rates of anti-anginal drugs are low in the patients with stable angina pectoris in China, regardless of the levels and types of hospitals. Compared with non-radiographic diagnosis group, the drug use is sufficient in revascularization and/or radiographic diagnosis groups.