北京地区2型糖尿病患者他汀类药物使用状况调查

Current status on the use of statins in patients with type 2 diabetes mellitus in Beijing

目的调查北京地区2型糖尿病(T2DM)患者他汀类药物的使用情况。方法对2015年8月至2016年3月北京共6家医院住院和门诊T2DM患者进行非干预性观察性研究。采用调查问卷,根据他汀类药物使用情况,患者被分为他汀类药物现使用组、既往他汀类药物使用组以及他汀类药物未使用组。采用方差分析或t检验对各组糖尿病患者他汀类药物使用情况、血脂达标率进行比较,并采用logistic回归分析评价停用他汀类药物的影响因素。结果共纳入T2DM患者1518例,其中他汀类药物现使用组占45.9%(696/1518)、既往他汀类药物使用组占10.9%(166/1518)、他汀类药物未使用组占43.2%(656/1518)。总胆固醇(TC)达标率为52.0%(789/1518),总低密度脂蛋白胆固醇(LDL-C)达标率为54.0%(820/1518),总甘油三酯(TG)达标率60.7%(922/1518)。糖尿病患者≥65岁者(639例)血脂达标率均高于<65岁者(879例),差异有统计学意义(P<0.001)。他汀类药物现使用组TC和LDL-C达标率高于他汀类药物既往使用组以及他汀类药物未使用组(均P<0.001)。患者停用他汀类药物的主要原因为认为自己血脂控制良好(33.1%,79/239)、害怕药物不良反应(29.3%,70/239)、服药后出现不良反应(18.4%,44/239)。logistic回归分析显示,年龄≥65岁(OR=1.847,95%CI为1.088~3.134,P=0.023)、病程≥10年(OR=2.752,95%CI为1.369~5.531,P=0.039)、糖尿病了解程度低(OR=3.209,95%CI为1.393~7.393,P=0.006)、不了解LDL-C目标值(OR=4.111,95%CI为1.364~12.390,P=0.012)与停用他汀类药物有关。结论他汀类药物使用组血脂达标率优于既往他汀类药物使用组和未使用组,北京地区T2DM患者中他汀类药物的使用仍明显不足。

Objective To investigate the use of statins in patients with type 2 diabetes(T2DM)in Beijing.Methods A non-interventional observational study of inpatients and outpatients with T2DM in a total of 6 hospitals from August 2015 to March 2016.According to the questionnaire,the patients were divided into the current statin use group,the previous statin use group and the statin non-use group.Variance analysis or t test analysis was used to compare the use of statins and the compliance rate of blood lipids among diabetic patients in each group,and logistic regression analysis was used to evaluate the influencing factors of discontinuation of statins.Results A total of 1518 patients with T2DM were included in the study,of which 45.9%(696/1518)were current statin users,10.9%(166/1518)were former statin users,and 43.2%(656/1518)were non-users of statins.The compliance rates of total cholesterol(TC),total low-density lipoprotein cholesterol(LDL-C)and total triglyceride(TG)were 52.0%(789/1518),54.0%(820/1518)and 60.7%(922/1518),respectively.The blood lipid compliance rate of diabetic patients≥65 years old(639 cases)was higher than patients younger than 65 years old(879 cases);current statin users had higher TC and LDL-C compliance rates than former statin users and statin non-users(both P<0.001).The reasons why patients stopped using statins were as follows:33.1%(79/239)of people believed that their blood lipids were well controlled;29.3%(70/239)were afraid of side effects of drugs;18.4%(44/239)had side effects after taking the drugs.According to logistic regression analysis,age≥65 years(OR=1.847,95%CI 1.088-3.134,P=0.023),diabetic course≥10 years(OR=2.752,95%CI 1.369-5.531,P=0.039),poor understanding of diabetes(OR=3.209,95%CI 1.393-7.393,P=0.006)and LDL-C target intervals(OR=4.111,95%CI 1.364-12.390,P=0.012)were related with discontinuation of statins.Conclusions The success rate of blood lipids of current users of statins is higher than that of previous users and non-users of statins.The use of statins in patients with T2DM in Beijing is still significantly insufficient.