急性心肌梗死患者血管紧张素转化酶抑制剂和血管紧张素受体阻滞剂的应用及影响因素

Application of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Acute Myocardial Infarction

目的了解天津市静海区急性心肌梗死(AMI)患者中血管紧张素转化酶抑制剂和血管紧张素受体阻滞剂(ACEI/ARB)的使用情况,并探讨其影响因素。方法通过调查天津市静海区医院2001、2006、2011三个特定年份的研究病历,分析ACEI/ARB的使用情况,并采用二元logistic回归方法探讨其使用的影响因素。结果共入选598例患者,其中中国指南Ⅰ类推荐组589例,指南Ⅱa类推荐组9例。2001年、2006年和2011年,指南Ⅰ类推荐患者ACEI/ARB使用率分别为69.86%、64.11%和69.97%(P>0.05),2001年、2006年和2011年指南Ⅱa类推荐患者为32.65%、33.33%和50.00%(P>0.05)。ACEI/ARB使用率随时间推移呈小幅提高。在3个研究年份中,ACEIs使用率均显著高于ARBs。多因素分析显示,与对应组相比合并高血压(OR 2.20,95%CI 1.50~3.30)、心力衰竭(OR 1.70,95%CI 1.20~2.60)的患者更倾向于使用ACEI/ARB,相反,合并e GFR<60m L/(min·1.73m^2)的患者较少使用ACEI/ARB(OR 0.30,95%CI 0.20~0.70)。结论约三分之一静海区急性心肌梗死Ⅰ类推荐患者住院期间未接受ACEI/ARB治疗,随时间推移呈小幅提高。

OBJECTIVE To evaluate patterns of angiotensin-converting enzyme inhibitors / angiotensin receptor blockers（ ACEI / ARB） therapy in patients with Acute Myocardial Infarction（ AMI） in Tianjin Jing hai from 2001 to2011,and identify factors affecting use of ACEI / ARB use. METHODS We collected clinical information of AMI patients in 2001,2006 and 2011,and analyzed pattern of ACEI / ARB therapy by year. Binary logistic regression analysis was used to identify factors related to the use of ACEI / ARB. RESULTS We included 598 eligible patients,of which 589 were eligible for Class I indication by Chinese guidelines and 9 were eligible for Class Ⅱ a indication. From 2001 to 2011,there was little improvement in the use of ACEI / ARB in both patients with Class I indication（ 69. 86% 、64. 11% and 69. 97%,P〉0. 05） and those with Class Ⅱ a indication（ 32. 65% 、33. 33% and50. 00%,P〉0. 05）. Among three specific study years,use rate of ACEIs was noticeably higher than that of ARBs. Binary logistic regression analysis showed that patients who complicated with hypertension（ OR 2. 20,95% CI1. 50 ~ 3. 30）,heart failure（ OR 1. 92,95% CI 1. 40 ~ 2. 62） were more likely to be treated with ACEI / ARB,and patients with e GFR〈60 m L /（ min·1. 73m^2）（ OR 0. 30,95% CI 0. 20 ~ 0. 70） were less likely to be treated with ACEI / ARB. CONCLUSION One third of Tianjin Jinghai AMI patients with Class I indications do not receive ACEI / ARB therapy during hospitalization,with little improvement in rates over time.