摘要目的 了解21省市自治区门诊老年冠心病合并糖尿病患者血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)类药物应用现况及影响因素.方法 2011年4至7月对全国21个省市自治区165家医院门诊的老年冠心病患者(≥60岁)进行多中心、非干预性、横断面的临床流行病学调查,对纳入研究的1 789例老年冠心病合并糖尿病患者ACEI/ARB类药物应用情况及影响因素进行现况调查.结果 在纳入研究的1 789例患者中,1 069例患者使用ACEI/ARB类药物(使用率为59.8％),在使用药物种类方面,ACEI与ARB类药物使用比例基本相同,544例(30.4％)患者使用ACEI,533例(29.8％)患者使用ARB;28例(1.6％)患者同时使用ACEI+ ARB;ACEI/ARB类药物使用率男性略高于女性,且使用率随着年龄的增加有降低趋势,但差异均无统计学意义(均P ＞0.05);ACEI/ARB使用率随着冠心病或糖尿病病程的增加而逐渐降低(均P＜0.05),伴有高血压、血脂异常、心肌梗死、肾功能不全、接受过血运重建治疗的患者中ACEI/ARB使用率较高(均P＜0.05).多因素logistic回归分析显示:合并高血压(OR =3.016,95％ CI:1.376 ～4.887)、血脂异常(OR=1.489,95％ CI:1.114 ～2.031)、心肌梗死(OR =2.561,95％CI:1.571 ～4.545)、肾功能不全(OR=1.337,95％CI:1.145 ～2.013)、血运重建治疗(OR =2.291,95％CI:1.276 ～3.277)、胰岛素治疗(OR=1.584,95％CI:1.084 ～2.511)与患者使用ACEI/ARB类药物呈正相关(P＜0.05);而冠心病病程较长与患者使用ACEI/ARB类药物呈负相关(病程5～10年:OR=0.621,95％CI:0.416 ～0.823;病程＞10年:OR=0.664,95％CI:0.471 ～0.840).结论 门诊老年冠心病合并糖尿病患者ACEI/ARB使用率仍旧较低,临床特殊患者如合并高血压、血脂异常、心肌梗死、肾功能不全、接受过血运重建及胰岛素治疗的患者ACEI/ARB使用率较高,应当进一步提高患者ACEI/ARB使用率,增强循证医学意识及推进冠心病二级预防策略以改善患者预后.

abstractsObjective To investigate the current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in 21 provinces of China.Methods In this muhicenter,non-intervention and cross-sectional survey,the elderly coronary heart disease patients aged 60 years or over were recruited from 165 hospitals in 21 provinces across China from April to July 2011.Current status and influence factors of ACEI/ARB application among 1 789 cases with diabetes mellitus were investigated in the survey.Results Totally,1 069 patients used ACEI/ARB drugs (59.8％);proportion of ACEI (544 cases,30.4％) drugs were the same as ARB drugs (533 cases,29.8％) in terms of usage of drug types,and combination of the two drugs were taken by 28 cases (1.6％) at the same time.ACEI/ARB usage decreased with the increasing of age,and the rate of drug usage in male patients was slightly higher than that in female,however there was no statistical difference (both P ＞ 0.05);the rate of usage of ACEI/ARB drugs gradually decreased with increasing of coronary heart disease or diabetes duration (P ＜ 0.05);the rates of usage of ACEI/ARB drugs in hypertension,dyslipidemia,myocardial infarction,renal insufficiency patients and patients received revascularization therapy were significantly higher (all P ＜ 0.05).Multivariable logistic regression analysis showed that hypertension (OR=3.016,95％ CI:1.376-4.887),dyslipidemia (OR =1.489,95％ CI:1.114-2.031),revascularization (OR =2.291,95％ CI:1.276-3.277),myocardial infarction (OR =2.561,95％ CI:1.571-4.545),renal insufficiency (OR =1.337,95％ CI:1.145-2.013),and insulin treatment (OR =1.584,95％ CI:1.084-2.511) were positively correlated with ACEI/ARB usage (P ＜ 0.05);and coronary heart disease duration was negatively correlated with ACEI/ARB drugs usage (duration 5-10 years:OR =0.621,95％ CI:0.416-0.823;duration ＞ 10 years,OR =0.664,95％ CI:0.471-0.840).Conclusions The rate of usage of ACEI/ARB drugs in elderly coronary heart disease outpatients complicated with diabetes mellitus is still low,however,patients with hypertension,dyslipidemia,myocardial infarction,renal insufficiency and patients received revascularization therapy and insulin treatment are more likely to use ACEI/ARB drugs.