中国中部农村地区急性心肌梗死心肌标志物检测情况十年趋势

Trends in Cardiac Biomarker Testing in Acute Myocardial Infarction in Central Rural China from 2001 to 2011

目的评价2001-2011年间我国中部农村地区医院心肌标志物检测的应用情况,在急性心肌梗死(AMI)患者中的检测情况及变化趋势。方法采用两阶段随机抽样获得2001、2006和2011年具有中部农村代表性的AMI患者样本,通过收集相应病历及对协作医院开展问卷调查,分别获取AMI患者的住院临床资料及医院特征信息,描述各医院肌钙蛋白和肌酸激酶同工酶(CK-MB)检测的开展情况,AMI患者中心肌标志物检测率及变化趋势,以及有检测能力的医院中心肌标志物的应用率。结果来自中部农村地区35家医院的1694份AMI病历被纳入研究。2001年、2006年、2011年开展肌钙蛋白或CK-MB检测的医院比例分别为20.0%、72.9%和91.6%(趋势P值<0.001),开展肌钙蛋白检测的医院比例分别为2.9%、31.5%和67.0%(趋势P值<0.001)。十年间AMI患者中肌钙蛋白或CK-MB的检测率明显增长,分别为15.0%、54.9%和89.8%(趋势P值<0.001),其中肌钙蛋白的检测率2001年为0.77%,2011年升至39.8%(趋势P值<0.001)。在具备肌钙蛋白检测能力的医院中,各医院检测率有明显的差异且十年间无明显变化,2011年仍有40.9%的医院检测率不足50%。结论 2001年至2011的十年间,中部农村地区医院心肌标志物的检测已逐渐普及,但肌钙蛋白检测的开展及应用情况仍存在较大改善空间,应提高肌钙蛋白检测能力,着力推广肌钙蛋白检测,提高AMI诊断的敏感性。

Objective To describe trends in the availability of cardiac biomarker testing in central rural Chinese hospitals and trends of its application in patients with acute myocardial infarction （AMI） from 2001-2011. Methods An observational study was performed on 69 patients with asymptomatic severe carotid artery stenosis and coronary heart disease receiving simultaneous CEA and CABG in Fuwai hospital during January, 2005 to January, 2015.They were divided into two group： On-pump group and Off-pump group （n = 36, 33）. The patient,s major adverse cerebral and cardiovascular events and death were studied. Results We sampled 35 central rural Chinese hospitals, and 1694 patients with AMI were included in the analysis. The proportion of hospitals with biomarker testing capability （troponin or CK-MB） was 20.0%, 72.9%, and 91.6% in 2001, 2006 and 2011, respectively （P for trend 〈0.001）. The proportion of hospitals with troponin testing capability also increased significantly over years （2.9%, 31.5%, and 67.0%; P for trend 〈0.001）. The rates of cardiac biomarker testing for patients with AMI increased from 15.0% in 2001, to 54.9% in 2006, and then 89.8% in 2011 （P for trend 〈0.001）, with the proportion of troponin testing 0.77% in 2001 and 39.8% in 2011. There was marked variation in use of troponin testing among hospitals with the corresponding capability, and the pattern has not changed much over the decade. In 2011, 40.9% of hospitals that were capable for troponin testing had troponin test rates less than 50%. Conclusions From 2001 to 2011, the access to cardiac biomarker testing has increased in central rural China, however, there were still substantial rooms for improvement in troponin testing among patients with AMI. It will improve the diagnosis of AMI by strengthen the hospital capability of troponin testing and increase its application in potential AMI patients.