急性缺血性脑卒中及短暂性脑缺血发作患者口服二级预防药物1年复合依从性影响因素分析

Influencing factors for one-year composite adherence of secondary prevention medications in patients with acute ischemic stroke and transient ischemic attack

目的 观察急性缺血性脑卒中(AIS)及短暂性脑缺血发作(TIA)患者二级预防药物1年复合依从性的影响因素。方法 收集2926例AIS及TIA患者的基线资料及3个月、6个月、1年随访时服药情况。基线资料包括:人口学信息(年龄、性别、民族、医保类型、文化程度、家庭人均月收入、BMI指数)、既往史(吸烟史、饮酒史、高血压史、糖尿病史、脂代谢紊乱史、房颤史、TIA史、AIS史、心肌梗死史,既往服用抗栓药物史、降压药物史、降脂药物史、降糖药物史)、病情概况[发病前改良Rankin量表(mRS)评分,入院时美国国立卫生研究院卒中量表(NIHSS)评分、是否静脉溶栓、住院费用、出院时NIHSS评分、出院时mRS评分、脑卒中类型(AIS、TIA)]、出院带药种类数(仅限于抗栓药、降压药、降脂药、降糖药)。以患者药物复合依从率≥75%为界,将研究对象分为1年复合依从性好组(1257例,占43.0%)、1年复合依从性差组(1669例,占57.0%),比较两组患者的基线资料。将两组基线资料比较中P<0.2的自变量纳入Logistic回归模型,采用向后逐步剔除LR法进行多因素分析。结果 年龄、既往高血压史、既往脂代谢紊乱史、既往服用降压药物史、既往服用降糖药物史、住院费用、脑卒中类型、出院带药种类数等是AIS及TIA患者二级预防药物1年复合依从性的独立影响因素(P均<0.05)。结论 AIS及TIA患者的年龄、既往高血压史、既往脂代谢紊乱史、既往服用降压药物史、既往服用降糖药物史、住院费用、脑卒中类型、出院带药种类数与二级预防药物1年复合依从性有关。

Objective To observe the influencing factors of one-year composite adherence of secondary prevention medications in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA). Methods We obtained the baseline data and follow-up data of 2 926 subjects with AIS or TIA. Baseline data included demographic information (age, gender, ethnicity, the type of medical care, the education level, the monthly income of the family, and BMI), past history (smoking history, drinking history, previous history of hypertension, previous diabetes, previous lipid metabolism disorder, previous atrial fibrillation, previous TIA, previous cerebral infarction, previous myocardial infarction, history of antithrombotic drugs, history of antihypertensive drugs, history of lipid-lowering drugs, and history of hypoglycemic drugs), condition profile [modified Rankin Scale (mRS) score before onset, admission National Institute of Health Stroke Scale (NIHSS) score, intravenous thrombolysis or not, receiving intravenous thrombolytic therapy, hospitalization expenses, discharge NIHSS score, discharge mRS score, and type of cerebrovascular disease (AIS and TIA)], and the number of drugs discharged from hospital (only for antithrombotic, antihypertensive, lipid lowering, and hypoglycemic drugs). According to patients’ one-year medication composite adherence≥75%, we divided patients into two groups: the high composite adherence group (1 257 cases, accounting for 43%) and low composite adherence group (1 669 cases, accounting for 57%), and then compared baseline data between the two groups. The independent variables of P <0.2 in the comparison of the two baseline data were included in the multivariable logistic regression model. Multivariate analysis was performed by Backwards LR. Results Age, previous history of hypertension, history of previous lipid metabolism disorder, history of previous taking antihypertensive drugs, previous history of taking hypoglycemic drugs, hospitalization expenses, type of stroke, number of drugs discharged from hospital, etc.were independent risk factors for one-year composite adherence of secondary prevention medications of patients with AIS and TIA1. Conclusion The age, previous history of hypertension, previous lipid metabolism disorder, history of antihypertensive drugs, history of hypoglycemic drugs,hospitalization expenses, type of cerebrovascular disease, and the number of drugs discharged from hospital are related to one-year composite adherence of secondary prevention medications in patients with AIS and TIA.