中国急性缺血性卒中及短暂性脑缺血发作二级预防药物依从性的现状

Current Status of Medication Compliance in Secondary Prevention for Ischemic Stroke or Transient Ischemic Attack

目的评估中国急性缺血性卒中和短暂性脑缺血发作(transient ischemic attack,TIA)患者二级预防药物依从性的现状。方法中国国家卒中登记研究Ⅱ(China National Stroke Registry,CNSRⅡ)2012年6月-2013年1月连续入组急性缺血性卒中和TIA的住院患者25 018例,收集患者人口学信息、临床特点及用药信息等资料,统计患者发病后3个月、6个月及12个月的药物依从性。按照随访12个月时患者二级预防药物依从性分为依从组和非依从组,比较两组患者的各因素特点,并对影响因素进行多因素分析。结果 16 489例急性缺血性卒中和TIA患者完成12个月的随访。缺血性卒中二级预防药物总体依从性3个月、6个月、12个月分别为47.0%、44.5%和34.9%。出院12个月时二级预防药物依从性最好的为降糖药(63.86%),之后分别为降压药(61.9%)、抗血小板药(57.58%)、华法林(44.92%)和他汀类药物(24.36%)。二级预防药物依从性多因素分析结果显示:高龄、女性、既往糖尿病史、本次发病为TIA是卒中二级预防药物依从性偏低的影响因素,而既往有卒中病史的患者药物依从性相对较好。结论中国急性缺血性卒中和TIA患者二级预防药物总体依从性仍偏低,且随时间的延长逐渐下降。

Objective To investigate the status of medication compliance in secondary prevention for ischemic stroke（IS） or transient ischemic attack（TIA）.Methods From June 2012 to January 2013, 25 018 patients with acute ischemic stroke（AIS） or TIA were admitted in the China National Stroke Registry Ⅱ（CNSR Ⅱ）. The data of patients＇ demographics, clinical features and medications use in secondary prevention at 3, 6 and 12 months were collected. Medication persistence at 3, 6 and 12 months was defined as continuation of prescribed medications from discharge to every follow-up point. According to the drug compliance at 12 months, these patients were divided into compliance and noncompliance groups. The factor feature of both groups were compared, and multifactor analysis was conducted to identify the influence factors of drug compliance.Results 16 489 patients who completed 1-year follow-up were analyzed. The rate of secondary prevention medications compliance at 3, 6 and 12 months were 47.0%, 44.5% and 34.9%, respectively. Drugs compliance at 12 months after discharge as follows： the best compliance was diabetes drugs（63.86%）, followed by antihypertensive drugs（61.9%）, antiplatelet drugs（57.58%）, warfarin（44.92%）,and statins（24.36%）. Multi-factor analysis showed that elder age, female, history of diabetes mellitus, and TIA of cerebrovascular events were influence factors of poor compliance to secondary prevention drugs treatment, while patients with history of stroke had better compliance to secondary prevention drugs.Conclusion The compliance of secondary prevention medications within 12 months in patients with IS and TIA were relatively low, and declined gradually over time.