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目的了解2001至2011年间中国中西部城市地区急性心肌梗死(AMI)患者住院期间他汀类药物的使用情况和变化趋势,并探讨其使用的影响因素。方法通过两阶段随机抽样设计,获得中国中西部城市地区AMI患者代表性样本。第一阶段,采用简单随机抽样确定协作医院。第二阶段,选取2001、2006和2011 3个特定年份,在协作医院中采用系统随机抽样方法,抽取研究病历,提取临床信息。对每年度分别进行加权处理。采用二元Logistic回归模型分析影响他汀使用的因素。结果共计31家医院3354份AMI病历纳入研究。2001、2006和2011年,AMI患者院内他汀的使用率随着年份递增而大幅增加,分别为19.7%、79%、91.1%(趋势P值<0.001)。不同低密度脂蛋白胆固醇(LDLC)水平的患者院内接受他汀治疗率均随年份递增显著增加。主要他汀类药物的使用类型所占比例变化明显,2001年洛伐他汀使用比例最大,2011年阿托伐他汀成为最常用的他汀类药物。多因素模型分析中,吸烟患者较不吸烟患者更容易接受他汀类药物治疗(OR 1.36,95%CI 1.07~1.73,P=0.011)。结论既往10年间,中国中西部城市AMI住院患者的他汀使用情况明显改善,指南对于他汀的推荐在临床实践中得到快速普及,但仍存在改善空间。
Objective To understand the statin use and trends during inpatients with acute myocardial infarction (AMI) in urban areas of central and western China from 2001 to 2011 and to explore the influential factors of statin use. Methods A representative sample of patients with AMI in urban areas of central and western China was obtained through two-stage random sampling design. In the first phase, a simple random sampling was used to identify collaborating hospitals. In the second stage, three specific years of 2001, 2006 and 2011 were selected. Randomized sampling method was adopted in the collaborative hospital to extract the medical records and extract the clinical information. Weighted each year separately. Binary Logistic regression model was used to analyze the factors influencing statin use. Results A total of 3354 AMI cases in 31 hospitals were included in the study. In 2001, 2006 and 2011, the rate of in-hospital statin use in AMI patients increased significantly with age (19.7%, 79%, 91.1%, respectively) (trend P value <0.001). In patients with different levels of low-density lipoprotein cholesterol (LDLC) received statin therapy rates were increased significantly with increasing year. The proportion of major statin use varies significantly with the largest use of lovastatin in 2001, with atorvastatin becoming the most commonly used statin in 2011. In the multivariate model analysis, smokers were more likely to receive statin therapy than non-smokers (OR 1.36, 95% CI 1.07-1.73, P = 0.011). CONCLUSIONS: In the past 10 years, statin use was significantly improved in AMI inpatients in the central and western cities of China. The guidelines for statin recommendations have gained rapid popularity in clinical practice, but there is still room for improvement.