摘要目的 探讨老年冠心病患者住院治疗和二级预防存在问题与防治策略. 方法 对北京市和天津市三级甲等中医或中西医结合医院老年冠心病患者进行前瞻性研究,利用冠心病个体化诊疗信息采集平台,采用纵向临床流行病学调查方法,实时采集冠心病住院患者临床资料及出院后1年的终点指标和事件发生情况,以相关指南为评价依据.评价老年冠心病患者诊疗状况,对影响终点指标和事件的相关因素进行单因素和多因素分析. 结果 1864例老年冠心病患者符合入选标准,男性1113例,女性751例.年龄60～98岁,平均(72.2±6.8)岁,主要并存疾病是高血压、糖尿病、脑血管病、高脂血症.入院时并存高脂血症患者血脂水平达标率分别为总胆固醇(TC)74.1%(1381例)、三酰甘油(TG)32.9%(613例)、低密度脂蛋白胆固醇(LDL-C)19.4%(362例)、高密度脂蛋白胆固醇87.8%(1637例);高血压患者收缩压达标率64.6%(857/1327),舒张压达标率84.7%(1124/1327).住院期间药物使用率:β受体阻滞剂69.6%(1297例),血管紧张素转化酶抑制剂或血管紧张素受体拮抗剂(ACEI或ARB)68.4%(1275例),他汀类调脂药63.6%(1186例),血运重建29.1%(391例).1682例患者完成随访观察,112例(6.0%)失访,随访期间心原性死亡72例(4.3%),其他原因死亡5例(0.3%),急性心肌梗死(AMI)9例(0.5%),血运重建15例(0.8%).多因素Logistic回归分析,可导致终点事件发生的因素有急性心肌梗死、心功能不全.可防止终点事件发生的因素有他汀调脂药物、无并存周围血管疾病、血运重建、中西医结合治疗、年龄<75岁. 结论 北京市和天津市中医及中西医结合医院老年冠心病患者在血脂达标(TG、LDL-C)方面不足,血运重建有待加强,ACEI或ARB、β受体阻滞剂和他汀类调脂药和相关指南的要求尚有差距,冠心病二级预防有待加强,规范地遵循指南从事医疗实践,多种危险因素共同控制、综合干预是预防老年冠心病患者心血管事件的主要策略.

abstractsObjective To prospectively study the diagnostic and therapeutic status and prognosis in elderly patients with coronary heart disease(CHD) in national 3rd class-A level hospitals of traditional Chinese medicine(TCM) or integrative western and Chinese medicine(IWCM) in Beijing and Tianjin. The problems and strategies of their in-hospital treatment and secondary prevention of CHD were analyzed combining with follow-up clinical events. Methods Using individualized Information Acquisition Platform of CHD, we collected in-hospital clinical information of CHD patients and then followed up for one year. The diagnostic and therapeutic conditions of elder CHD patients were evaluated based on clinical guidelines. The outcome-related indices were analyzed with one-way ANOVA and muhi-factors analysis. Results The average age of 1864 elderly CHD patients was (72.2±6.8) years, among those 1113 cases were male and 751 cases were female. The major accompanied diseases were hypertension, diabetes, cerebrovascular disease and hyperlipidemia.The standard-reaching rate of blood-lipid level of CHD patients with hyperlipidemia was as follows:TC 74.1%, TG 32. 9%, LDL-C 19. 4%, HDL-C 87. 8%, while it was 64.6% ( systolic pressure)and 84.70% ( diastolic pressure) respectively in CHD with hypertension. As for in-hospital treatment:β-receptor blocker 69.6%, ACEI/ARB 68. 4%, lipid-lowering statina 63. 6%, revascularization 29.1%. During the 12 months of follow-up, cardiogenic death 72 cases (4. 3%, 72/1682), other reasons 5 cases (0. 3%), acute myocardial infarction (AMI) 9 cases (0. 5%), revascularization 15cases (0. 8%). The multi-factors analysis showed that AMI, cardiac dysfunction could increase the incidence rate of endpoint events. Meanwhile, lipid-lowering statins, none of peripheral vessels disease, revaseularization, IWCM treatment, age below 75 years were related with the decreased incidence rate of endpoint events. Conclusions The standard-reaching rates of hlood-lipids (TG,LDL-C) of elderly CHD patients in TCM or IWCM hospitals in Beijing and Tianjin are insufficient,and revascularization should be intensified. There is still certain gap between the usage of ACEI/ARB,β-receptor blocker, lipid-lowering statins and related guidelines, and secondary prevention of CHD must be strengthened. It is the main strategy in preventing cardiovascular events to follow clinical guidelines in medical practice, control multiple risks factors and intervene comprehensively.