高胆固醇血症临床控制状况多中心协作研究——达标率及影响因素

目的 了解在目前的临床治疗下我国高胆固醇血症控制状况。方法 在全国12个大城市的25家3级甲等医院中，对服用调脂药物已≥2个月的高胆固醇患者（服药前总胆固醇≥5.72mmol/L或低密度脂蛋白-胆固醇≥3.64mmol/L)测定血清脂质，根据我国《血脂异常防治建议》标准计算血脂控制达到控制目标的人数和达标率。结果 （1）临床所见高胆固醇血症患者中，60岁以上患者占63.4%,门诊患者占75.4%，心内科患者占66.4%，混合型高胆固醇血症患者占62.5% ,使用他汀类药物占70.3%，不控制饮食者占18.3%。（2）总达标率为26.5%，其中有动脉粥样硬化性疾病（ASD）患者为16.6%，无ASD有危险因素（RF）患者为31.7%，无ASD无RF患者为44.9%，有显著性差异（P=0.001)；使用他汀类调脂药物者达标率为30.1%，贝特类为19.7%，其他类为14.3%，有显著性差异（P=0.001)；同时控制饮食者达标率为28.3%，不控制饮食者为18.2%，有显著性差异（P=0.001)。此外，影响达标率的因素还有治疗前的血脂水平，合并危险因素数目及文化程度等。结论 我国目前临床高胆固醇血症控制状况与我国《血脂异常防治建议》的要求相差甚远。重视高胆固醇的治疗，加强健康教育，强调非药物治疗，正确选择药物种类和科学调整药物剂量是目前尽快改善我国高胆固醇血症控制状况的有效措施。

A multi-center study of current status on clinical control of hypercholesterole mia in China: success rate and related factors

Objective To assess the current status on clinical control of hypercholesterolaemia among Chinese patients Methods 25 top level hospitals from 12 metropolitan cities in China were selected to recruit 2 136 patients suffering from hypercholesterolaemia and having been receiving the lipid lowering treatment (the same medication and same dosage)for at least 2 months Serum lipids level was determined for each patient at the time of enrollment, to assess whether the patients's serum lipid level reached the goal for treatment The success rate defined as the proportion of patients whose lipid level, both of low density lipoprotein cholesterol (LDL C) and total cholesterol (TC), achieved the goal for treatment according to the Chinese National Recommendations for Prevention and Treatment of Dislipidaemia Results 1) Among the 2 136 hypercholesterolaemia patients from the top hospitals in China, 47 2% were men,63 4% aged 60 years and over, 75 4% from outpatient departments, 66 4% treated by cardiologists, 62 5% with combined hypercholesterolaemia, 36 5% with atherosclerotic diseases(ASD), 70 3% using statin and 18 3% not in control of diet 2) The overall success rate was 26 5% It was 16 6% for patients with established ASD such as coronary heart disease (CHD), stroke and peripheral arteries diseases, 31 7% for patients without ASD but with risk factors (RF) including hypertesion, diabetes, smoking , family history, male gender, age, overweight /obesity and so on, 44 9% for patients without ASD and RF ( P =0 001 among the 3 groups) And it was 30 1% for patients using statin, 19 7% for those using fibrate, and 14 3% for those using other lipid lowering medications ( P =0 001 among the 3 groups) In addition, other factors related to the success rate included baseline lipid level, number of risk factors affected, education level of patients, etc Conclusions The current status in clinical control of hypercholesterolaemia is still lag far behind the goals of treatment established by Chinese National Recommendations for Prevention and Treatment of Dislipidaemia Putting treatment of hyercholesterolaemia in a key position, enhancing patient health education, strengthening non pharmaceutical treatment, choosing right medication and adjusting to the right dosage should be effective measures to improve as soon as possible the current status in clinical control of hypercholesterolaemia in China