中国西部农村地区医院急性心肌梗死心肌标志物检测情况十年趋势——China PEACE回顾性AMI研究结果

Trends in cardiac biomarker testing in hospitals and patients with acute myocardial infarction in western rural China from 2001 to 2011: China PEACE-retrospective AMI Study

目的评价2001~2011年间我国西部农村地区医院心肌标志物检测变化趋势,及其在急性心肌梗死(AMI)住院患者中的检测应用情况及变化趋势。方法采用两阶段随机抽样获得2001、2006和2011年具有西部农村有代表性的AMI住院患者样本,通过收集住院期间病历资料及对其所在医院进行问卷调查,获取AMI患者住院期间病历资料及医院一些基本特征,描述各医院肌钙蛋白和肌酸激酶同丁酶(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,以及在具有检测能力的医院中,计算心肌标志物检测的使用率。结果共有来自西部农村地区32家医院的1023份AMI住院病历被纳入研究。2001年、2006年、2011年开展心肌标志物检测(肌钙蛋白或CK-MB)检测的医院比例分别为19.05%、62.96%和90.32%(趋势P值<0.001),开展肌钙蛋白检测的医院比例分别为4.76%、37.04%和67.74%(趋势P值<0.001)。十年间AMI住院患者中肌钙蛋白或CK-MB的检测率显著增加,分别为56.5%、74.3%和96.8%(趋势P值<0.001),其中肌钙蛋白的检测率2001年为6.34%,2011年升至75.69%(趋势P值<0.001)。在具备肌钙蛋白检测能力的医院中,各医院检测率差异仍然十分明显,2011年仍有21.1%的医院检测率不足50%。结论2001~2011的十年间,西部农村地区医院心肌标志物的检测应用已经得到广泛推广,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,加大推广肌钙蛋白检测推广力度,提高AMI诊断的敏感性。

Objective To evaluate the availability of cardiac biomarker testing in western ural Chinese hospitals and trends of its application in patients with acute myocardial infarction(AMI) from 2001 to 2011. Methods A representative sample of patients in western rural China admitted to hospital for AMI was created from a two-stage sampling approach. Profiles for patients with AMI were abstracted through their medical records,and characteristics for hospitals were obtained via hospital questionnaire survey. The study described the temporal trends in the hospital capability and use rates of cardiac biomarker testing among patients with AMI, as well as the variation in use across hospitals with testing capability. Results1023 patients with AMI from 32 western rural Chinese hospitals were included in the analysis. The proportion of hospitals with biomarker testing capability(troponin or CK-MB) was 19.05%, 62.96%, and 90.32% in 2001, 2006 and 2011, respectively(P for trend 0.001). The proportion of hospitals with troponin testing capability also increased significantly over years(4.76%, 37.04%, and 67.74%;P for trend 0.001). The rates of cardiac biomarker testing for patients with AMI increased from 56.5% in 2001, to 74.3% in 2006, and then 96.8% in 2011(P for trend 0.001), with the proportion of troponin testing 6.34% in 2001 and 75.69% in 2011. There was marked variation in use of troponin testing among hospitals with the corresponding capability. In 2011, 21.1% of hospitals that were capable for troponin testing had troponin test rates less than 50%. Conclusion From 2001 to 2011, hospital cardiac biomarker testing capability has increased in western 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.