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目的了解我国临床血脂控制的最新现状,指导临床血脂异常防治实践。方法在全国21家省部级医院和6家地县级医院中,查阅2004年1月1日至2006年2月28日间开始服调脂药物,且同一药物同一剂量维持≥2个月的2237名患者病例资料,依据美国2004年国家胆固醇教育计划(NCEP)成人治疗组第三次报告(ATPBⅢ)及《中国成人血脂异常防治指南》标准计算血脂控制达标率。结果 (1)在符合任一血脂防治建议/指南的药物起始治疗标准的2094例患者中,80%来自省部级医院,60%为60岁以上,57%有胆固醇升高,15%无血脂异常,68%合并冠心病等动脉粥样硬化性疾病,75%合并高血压,80%为高危和极高危患者,84%使用他汀类药物,83%采取了不同程度的饮食治疗。(2)依据美国2004年 NCEP ATPⅢ最新报告,总达标率为34%,低危组、中危组、中高危组、高危组和极高危组达标率分别为85%、78%、61%、3 1%和22%,差异有统计学意义(趋势性检验 P<0.001);依据我国新的《成人血脂异常防治指南》,总达标率为50%,低危组、中危组、高危组和极高危组达标率分别为91%、77%、49%和38%,组间差异及趋势性检验均有统计学意义(P<0.001)。(3)联合用药者达标率为51%,单用他汀类35%,贝特类23%,烟酸类24%,其他类28%,组间差异有统计学意义(P<0.001)。(4)对1808例服用他汀类药物患者的多元 logistic 回归分析表明,他汀类药物剂量(高剂量比低剂量,OR=1.72,95%CI:1.15～2.58)、危险分层(极高危比低危,OR=0.02,95%CI:0.01～0.03)、基线 LDL-C[每升高0.259 mmol/L(10 mg/dl),OR=0.83,95%CI:0.80～0.86]和性别(女性比男性,OR=0.77,95%CI:0.60～0.99)等是影响达标率的主要因素。结论我国目前调脂药物的应用对象发生了很大变化,调脂治疗的目的已不单纯是为了降低胆固醇。临床血脂控制状况与各防治指南要求相距仍甚远,特别是高危和极高危患者。要进一步改善我国临床血脂控制状况,药物种类、药物剂量、联合治疗和治疗性生活方式改变等多方面均需要进一步提高。
Objective To understand the latest status of clinical blood lipid control in our country and to guide the practice of prevention and treatment of clinical dyslipidemia. Methods Twenty-one provincial and ministerial hospitals and six county-level hospitals in China were enrolled in this study. The patients taking the lipid-lowering drugs for the first time between January 1, 2004 and February 28, 2006 were enrolled and the same dose of the same drug was maintained for 2 months According to the third report of the American National Cholesterol Education Program (NCEP) Adult Treating Group in 2004 (ATPBⅢ) and the “Guidelines for Prevention and Treatment of Dyslipidemia in Chinese Adults”, 2237 patients were enrolled in the study. Results (1) Of 2,094 patients who met the criteria for initiation of treatment for any of the lipid-lowering recommendations / guidelines, 80% were from provincial and ministerial hospitals, 60% were over 60 years old, 57% had elevated cholesterol, and 15% Dyslipidemia, atherosclerotic disease such as 68% with coronary heart disease, 75% with hypertension, 80% with high-risk and very high-risk patients, 84% with statins and 83% with varying degrees of diet. According to the latest report of NCEP ATPⅢ in 2004, the total compliance rate was 34%. The compliance rates were 85%, 78%, 61% in low risk group, middle risk group, middle and high risk group, high risk group and very high risk group respectively. According to the new guidelines for prevention and treatment of dyslipidemia in adults in our country, the total compliance rate was 50%, while the low-risk group, moderate-risk group and high-risk group (91%, 77%, 49% and 38% respectively). The difference between groups and trend test were statistically significant (P <0.001). (3) The rate of compliance with combination therapy was 51%. Only 35% of statins, 23% of fibrates, 24% of niacin and 28% of other types had statistical significance (P <0.001). (4) Multivariate logistic regression analysis of 1808 patients taking statins showed that statin doses (high dose to low dose, OR = 1.72, 95% CI: 1.15 to 2.58), risk stratification OR = 0.02, 95% CI: 0.01-0.03), baseline LDL-C [0.259 mmol / L OR = 0.77, 95% CI: 0.60 ~ 0.99) were the main factors affecting the compliance rate. Conclusions Our current application of lipid-lowering drugs has undergone great changes, the purpose of lipid-lowering treatment has not simply to reduce cholesterol. Clinical control of lipid status and control guidelines are still far apart, especially in high-risk and very high-risk patients. To further improve the clinical control of blood lipid status in China, the types of drugs, drug doses, combination therapy and therapeutic lifestyle changes and other aspects need to be further improved.