【摘要】 目的:了解我国女性急性冠状动脉综合征(ACS)患者二级预防药物使用现状。方法:全国22个省市、自治区的34家协作医院,从2012年4月15日起,各协作医院连续入选符合标准的住院ACS病例≥90例,共收集病例3 391例。患者出院后分别在3个月、6个月时对其进行随访,调查患者二级预防药物使用及预后情况。结果:(1)女性ACS患者平均年龄较男性大(66.0岁vs.60.4岁,P<0.01);女性患者合并高血压、高胆固醇血症和糖尿病的比例显著高于男性(分别为76.0%vs.65.3%,43.8%vs.35.8%,38.1%vs.32.7%,P值均<0.01),女性吸烟率低于男性(5.2%vs.42.7%,P<0.01)。(2)女性患者ST段抬高心肌梗死的比例低于男性(15.6%vs.29.5%,P<0.01);女性行经皮冠状动脉介入治疗(PCI)治疗的比例低于男性(42.1%vs.56.6%,P<0.01)。(3)女性患者二级预防药物的使用率低于男性,其中氯吡格雷和ACEI/ARB的使用率分别低13.0%和10.2%;二级预防药物联合使用率较男性低17.9%。(4)除阿司匹林外,女性患者二级预防药物未使用原因主要是医生未处方(未处方率49.6%~80.4%);阿司匹林自行停药的比例占1/3。(5)与男性患者比较,女性患者出院6个月时LDLC和血压控制达标率低、再住院率和病死率高,但未达到统计学显著性。结论:与男性ACS患者比较,女性ACS患者年龄大,合并的危险因素多;二级预防药物的使用率较男性低;我国住院女性ACS患者指南推荐药物的应用尚有进一步改善的空间。更多还原

【Abstract】 Objective: To understand the current status of drug usage for secondary prevention of acute coronary syndrome( ACS) in women. Methods: This was a multi-center cross-sectional study involving 34 hospitals from 22 provinces of China. At least 90 patients with ACS were consecutively enrolled from each involved hospital since April 15,2012 according to a standard protocol,and a total of 3 391 patients with complete data were analyzed in this study. The drug usage for secondary prevention and prognosis were followed-up after 3 and6 months of discharges. Results:( 1) Female patients with ACS were older than male patients( average age:66. 0 vs. 60. 4 years,P < 0. 01). The proportions of female patients complicated with hypertension( 76. 0%vs. 65. 3%),hypercholesterolemia( 43. 8% vs. 35. 8%) and diabetes( 38. 1% vs. 32. 7%) were remarkably higher than that of male patients( all P < 0. 01). Moreover,the smoking rate was lower in females than in males( 15. 6% vs. 29. 5%,P < 0. 01).( 2) The proportions of female patients with ST segment elevated myocardial infarction( 15. 6% vs. 29. 5%) and under treatment for percutaneous coronary intervention( 42. 1%vs. 56. 6%) were lower than that of male patients( both P < 0. 01).( 3) The usage rate of drugs for secondary prevention was lower in female patients than in male patients,and thereof the usage rate of clopidogre and ACEI / ARB was reduced by 13. 0% and 10. 2%,respectively. In addition,the usage rate of combined drugs was reduced by 17. 9% in female patients compared with male patients.( 4) Except for aspirin,the major reason for the non-usage of drugs in female patients was without a prescription( ranging from 49. 6% to 80. 4%).However,the withdrawal accounted for 1 /3 for the non-usage of aspirin.( 5) The control rates for low-density lipoprotein cholesterol and blood pressure were lowered in female patients compared with male patients after 6months of discharges,whereas the rates of re-hospitalization and mortality were increased,and these changes did not reach a statistical significance. Conclusion: Female patients with ACS were relatively older,had more risk factors and lower usage rate of drugs for secondary prevention than male patients,indicating that there is still a lot of room for improvement in the application of the guidelines recommend medicine to female patients with ACS in China.更多还原