社区就诊血栓栓塞性疾病患者阿司匹林抗栓治疗情况分析

目的:了解阿司匹林在社区血栓栓塞性疾病二级预防实践中的应用,评价阿司匹林应用中存在的问题和影响因素。方法:研究为横断面调查,2013年8月至2013年9月在北京10城区各选择1所社区卫生服务中心。通过问卷调查,收集1个月内到社区就诊的具有血栓栓塞性疾病的患者抗栓治疗信息。结果:共收集研究对象465例,男性281例(60.4%),女性184(39.6%)。年龄30~89岁,平均年龄(64.5±10.3)岁。冠心病患者170例(36.6%),缺血性脑卒中患者159例(34.2%),同时伴有冠心病和缺血性脑血管病患者77例(16.6%)。阿司匹林服用例数为377例(81.1%),冠心病患者阿司匹林服用例数为143例(84.1%),缺血性脑卒中患者服用例数为137例(86.2%)。男性阿司匹服用率为84.3%(237例),女性为76.1%(140例),男性阿司匹林服用率高于女性(χ2=4.938,P=0.026)。就诊时317例处方阿司匹林,占总例数的68.2%,没有处方阿司匹林的患者中,60例(40.5%)因为尚有存药,45例(30.4%)因为禁忌症、或曾发生副作用而不适合用药。43例(29.1%)医生认为不需要服用。348例(98.6%)阿司匹林处方剂量为100mg。所有患者均服用阿司匹林肠溶片。318例对服药时间进行回答,165例(51.9%)餐前服药,153例(48.1%)餐后服药。结论:在社区就诊的血栓栓塞性疾病患者中阿司匹林的应用达到较高的水平,使用剂量合理。     

血清尿酸水平和甘油三酯关系的人群研究

目的探讨我国人群中血清尿酸水平和甘油三酯(TG)的关系。方法1999年在北京市自然人群中采用分层随机抽样的方法进行横断面调查。本研究对1239例资料完整者进行了分析。结果在男女两性中,高TG血症患病率随血清尿酸水平的升高呈明显的升高趋势。用分层的方法分别校正体重指数、HOMA指数和饮酒后,发现在同一体重指数水平、HOMA指数水平和饮酒水平的人群中高TG血症患病率均随尿酸水平的升高呈明显的升高趋势。采用logistic回归模型校正了年龄、性别、吸烟、饮酒、体重指数、HOMA指数和总胆固醇等因素后,以尿酸四分位最低层为对照,在尿酸第二、三、四分位层时患高TG血症的OR值分别为1·26(P=0·28)、1·88(P=0·002)、3·36(P<0·001)。结论血清尿酸水平与TG相关,且独立于年龄、肥胖、饮酒和胰岛素抵抗等因素。     

中国多省市急性冠状动脉综合征住院患者高胆固醇血症患病现况

Objective To estimate the current prevalence, awareness and treatment status of hypercholesterolemia among inpatients with acute coronary syndrome (ACS) in China. Methods Sixty-four hospitals across China, including 32 secondary hospitals and 32 tertiary hospitals were selected for baseline survey. Fifty inpatients diagnosed with ACS were recruited consecutively in each participated hospitals. Retrospective information for 2751 patients were collected, and the prevalence, awareness, and treatment status of hypercholosterolemia among the patients were analyzed. Results (1) Mean age of the patients was 65±11. Sixty-nine percent of the patients were males and 31.2% were females. Among them, 39.4% were diagnosed as ST-segment elevation MI, 8. 8% as non-ST-segment elevation MI and 51.8% as unstable angina. Twenty-seven percent of them had previous ACS history. (2) Hypercholesterolemia was found in 19. 6% ACS patients. Among 7 geographic districts (north China, east China, south China, middle China, northeast, northwest and southwest), the prevalence rate of hypercholesterolemia was highest (24.7%) in east China and lowest (10.0%) in middle China. Significant difference was observed among these areas. (3) Awareness rate of hypercholesterolemia was 12.2% among patients with hypercholesterolemia, with significant difference among various areas. Treatment rate was 66.7% among patients with known hypercholesterolemia, with the highest (83.3%) seen in south China and lowest (0%) in southwest area. (4) The prevalence, awareness rate and treatment rate of hypercholesterolemia were higher in recurrent ACS patients than in those without ACS history. Conclusions Nearly 20% ACS inpatients have hypercholesterolemia. It is essential to pay more attention on the treatment of hypercholesterolemia for the purpose of secondary prevention of cardiovascular disease.     

2007年至2009年北京市居民急性心肌梗死住院病死率及其分布特征的研究

目的:分析2007年至2009年北京市户籍人口25岁以上人群急性心肌梗死(AMI)患者住院病死率及其分布特征。方法:研究资料来源于北京市公共卫生信息中心的北京市出院病人信息系统。AMI住院病死率指住院期间因AMI死亡的患者占所有AMI住院患者的比例。结果:2007年至2009年北京市户籍人口25岁以上人群因AMI住院者共35 335例,其中男性占68.2%。3年中AMI患者平均住院病死率为10.0%,女性为14.3%,高于男性的7.9%(P<0.001)。在二级医院住院的AMI患者的住院病死率高于三级医院者(11.4%比9.0%,P<0.001),中医医院高于西医医院者(17.5%比9.5%,P<0.001)。ST段抬高AMI患者住院病死率高于非ST段抬高患者(9.4%比8.4%,P<0.001)。住院期间未接受经皮冠状动脉介入治疗者的住院病死率,明显高于接受该治疗者(14.4%比1.9%,P<0.001)。2007年、2008年和2009年北京市AMI年龄标化住院病死率分别为10.7%、9.8%和9.4%,3年间下降了12.1%,男女两性分别下降了11.1%和10.7%。结论:目前北京市AMI住院病死率仍然较高,但近3年来逐年下降,提示北京市AMI住院期间救治水平总体提高。不同特征AMI患者的住院病死率存在差异。研究结果为进一步改善北京市AMI的住院治疗水平提供了依据。