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目的评估2001-2011年间中国西部农村地区医院急性心肌梗死(acute myocardial infarction,AMI)患者住院期间他汀应用的变化趋势,并探讨其应用的影响因素。方法采用两阶段随机抽样设计方法,第一阶段,采用简单随机抽样的方法抽取西部农村地区医院。第二阶段,采用系统随机抽样方法在抽中的医院中抽取三个特定年份(2001、2006和2011年)的AMI住院病历。从抽取的病历中提取临床信息,计算AMI患者住院期间他汀使用率,采用广义估计方程的多水平多因素logistic回归模型分析影响他汀使用的因素。结果32家西部农村地区医院参与研究,随机抽取AMI住院患者病历1,282份,获得了1,247份(97.3%),其中1,034份AMI住院患者病历符合本文的入选标准。2001-2011年间,中国西部农村AMI患者住院期间他汀的使用率明显上升,从2001年的7.35%增加到2006年的64.42%,及2011年的88.57%(趋势P值<0.001)。2001,2006和2011年,使用最广泛的他汀类药物分别为洛伐他汀、辛伐他汀和阿托伐他汀。影响因素分析结果显示,2011年,只有吸烟是影响AMI患者他汀使用的危险因素,吸烟患者他汀的使用率高于未吸烟患者(OR=2.22;95%CI 1.04-4.73,P=0.04)。结论 2001-2011年间,中国西部农村地区医院AMI患者住院期间他汀使用率大幅提高,指南对于他汀的推荐在临床实践中快速普及,但是西部农村地区医院他汀使用率仍然存在改善空间。
Objective To evaluate the trends of statin use in hospitalized patients with acute myocardial infarction (AMI) in rural areas of western China from 2001 to 2011 and to explore the influencing factors of statin application. Methods A two-stage random sampling design was adopted. In the first stage, hospitals in western rural areas were extracted by simple random sampling. In the second phase, a systematic random sampling method was used to extract AMI inpatient records for three specific years (2001, 2006 and 2011) in the pumping hospitals. The clinical information was extracted from the extracted medical records to calculate the statin usage during hospitalization in AMI. The multi-level multivariate logistic regression model using generalized estimating equation was used to analyze the factors influencing statin use. Results Thirty-two hospitals in western rural areas were involved in the study. Of 1,282 patients (97.3%) with AMI inpatients randomly selected, 1,034 AMI patients met the inclusion criteria of this study. During 2001-2011, the rate of statin use in rural AMI patients in western China increased significantly from 7.35% in 2001 to 64.42% in 2006 and 88.57% in 2011 (trend P value <0.001). In 2001, 2006 and 2011, the most widely used statins were lovastatin, simvastatin and atorvastatin. The analysis of influencing factors showed that in 2011, only smoking was the risk factor for statin use in AMI patients. The statin use rate in smokers was higher than that in non-smokers (OR = 2.22; 95% CI 1.04-4.73, P = 0.04). Conclusion During the period of 2001-2011, the rate of statin use in hospitalized patients with AMI in rural areas of western China increased significantly. The recommendations of statin for the guidelines were rapidly popularized in clinical practice. However, the statin utilization rate in western rural areas still has room for improvement.