老年患者调脂治疗达标状况分析

目的初步了解2007年血脂异常防治指南颁布后老年患者的调脂治疗达标情况。方法选择2009年2～7月在我院老年病房住院并服用他汀类药物治疗4周以上的男性患者144例,按照2007年中国成人血脂异常防治指南危险分层方案,分为高危组(65例)和极高危组(79例),并按指南规定的不同危险分层血脂控制目标值,判断调脂治疗是否达标,分析可能影响达标率的因素。结果高危组与极高危组患者多数服用阿托伐他汀治疗,平均治疗剂量差异无统计学意义。服药4周后,2组间TC、LDL-C、TG及HDL-C水平差异无统计学意义。TC总达标率为41.7%,LDL-C总达标率为54.9%,TC+LDL-C总达标率为41.7%。高危组TC、LDL-C及TC+LDL-C达标率分别为67.7%、70.8%和66.2%;极高危组达标率分别为20.3%、41.8%和21.5%(P0.05)。多因素logistic回归分析显示,极高危组达标率与年龄、冠心病、高血压、糖尿病、周围血管疾病及糖尿病控制情况无明显相关性。结论目前,老年患者的调脂治疗达标率仍较低,与指南要求存在较大差距,其中的影响因素值得进一步探讨。

Analysis of the goal attainment of lipid modulation in the elderly

Objective To investigate the effects of recent Guideline for Dyslipidemia on goal attainment rate of lipid modulation in the elderly.Methods In-patients of the geriatric wards from Feb. to July in 2009 were screcned.144 male patients taking statins for more than 4 weeks were enrolled. Stratification was performed according to the 2007 Guideline for China Adults with Dyslipidemia and the patients were divided into high risk group(65 cases) and very high risk group(79 cases).The rate of goal attainment was calculated according to specific goal for different risk levels. Multivariate analysis was performed to look for potential factors influencing goal attainment. Results 144 male cases were enrolled,median age 82,45.1% with high risk and 54.9% with very high risk.Most of them were taking atorvastatin with similar dosage (P > 0.05).The rates of goal attainment for TC,LDL-C and both TC and LDL-C in all patients were 41.7%,54.9% and 41.7% respectively.The rates of goal attain-ment for TC,LDL-C and both TC and LDL-C in patients with high risk were 67.7%,70.8% and 66.2% respectively.The rates of goal attainment for TC,LDL-C and both TC and LDL-C in patients with very high risk were 20.3% ,41.8% and 21.5% respectively,which were dramatically lower than those in patients with high risk (P < 0.05).Multivariate logistic analysis showed that age,coronary heart disease,hypertension,diabetes, peripheral vascular disease had no correlation with no correlation with goal attainment in patients with very high risk.Conclusion The rate of goal attainment for lipid modulation in the elderly still does not fulfil the reqnirement of recent Guideline for Dyslipidemia.The potential reason needs to be further analyzed.