摘要
目的通过调查老年心血管疾病二级预防、一级预防人群抗血小板药物使用现状,探讨不同预防策略人群用药的影响因素。方法选取2021年6—8月在上海市宝山区淞南镇社区卫生服务中心参加基本信息调查和健康体格检查(简称体检)的老年社区居民作为研究对象。通过问卷形式对进行健康体检的社区老年居民的人口学资料、病史资料和抗血小板药物使用情况进行调查。比较不同心血管预防策略人群抗血小板治疗情况,采用单因素和多因素logistics回归分析一级预防和二级预防患者抗血小板药物使用的影响因素。结果5275例被调查者动脉粥样硬化性心血管疾病(ASCVD)风险评估结果:极高危风险952例(18.0%)纳入二级预防,高危风险1505例(28.5%)和低中危风险2818例(53.4%)纳入一级预防。心血管疾病二级预防的952例中,使用抗血小板药物治疗组(使用组,501例)与未使用抗血小板药物治疗组(未使用组,451例)间男性、高龄(年龄≥80岁)、糖尿病、冠心病(CAD)、AMI、曾行PCI或冠状动脉旁路移植术(CABG)或颈动脉支架成形术(CAS)、缺血性脑卒中或短暂性脑缺血发作(TIA)、认知功能障碍、出血或有出血倾向、使用他汀类药物及服药种类≥5种的患者占比比较,差异均有统计学意义(P值均<0.05);两组间肥胖、高血压的患者占比比较,差异均无统计学意义(P值均>0.05)。心血管疾病一级预防的4323例中,使用抗血小板药物治疗组(使用组,369例)与未使用抗血小板药物治疗组(未使用组,3954例)间高血压、糖尿病、血脂异常、肥胖、心血管疾病累积个数(≥3个),以及不建议用药因素中年龄≥70岁的患者占比比较,差异均有统计学意义(P值均<0.05);两组间吸烟、血小板计数减少、CKD 4或5期和建议用药的患者占比比较,差异均无统计学意义(P值均>0.05)。单因素logistic回归分析结果显示:男性、年龄≥80岁、糖尿病、CAD、AMI史、曾行PCI或CABG或CAS、缺血性脑卒中或TIA、出血或有出血倾向、认知功能障碍、服药种类≥5种、使用他汀类药物是二级预防人群抗血小板药物使用的影响因素(P值均<0.05);腔隙性脑梗死史、使用他汀类药物、出血或有出血倾向、曾得到医嘱抗血小板药物治疗是一级预防人群抗血小板药物使用的影响因素(P值均<0.05);高血压、糖尿病、血脂异常、肥胖、ASCVD高危、年龄≥70岁、心房颤动(简称房颤)、腔隙性脑梗死史、使用他汀类药物、曾得到医嘱抗血小板药物治疗是一级预防不建议予抗血小板药物治疗的影响因素(P值均<0.05)。多因素logistic回归分析结果显示:糖尿病、CAD、AMI史、曾行PCI或CABG或CAS、缺血性脑卒中或TIA史、出血或有出血倾向、服药种类≥5种、使用他汀类药物是二级预防人群抗血小板药物使用的独立影响因素(P值均<0.05);腔隙性脑梗死史、使用他汀类药物、曾得到医嘱抗血小板药物治疗、出血或有出血倾向是一级预防人群抗血小板药物使用的独立影响因素(P值均<0.05);高血压、糖尿病、年龄≥70岁、房颤、腔隙性脑梗死史、使用他汀类药物、曾得到医嘱抗血小板药物治疗是一级预防人群不建议予抗血小板药物治疗的独立影响因素(P值均<0.05)。结论基层心血管疾病预防抗血小板药物使用不规范,存在应用未用和随意性。应加强二级预防患者,尤其是出血或有出血倾向、服药种类≥5种的患者综合用药指导;加强一级预防患者用药指征判断并及时纠正。
Objective To explore the current status and influencing factors of antiplatelet drug use among the elderly population for both secondary and primary prevention of cardiovascular diseases.Methods Elderly community residents who underwent the basic information survey and physical examination at the Songnan Town Community Health Service Center in Baoshan District,Shanghai,between June and August 2021 were selected as research subjects.Demographic data,medical history,and the use of antiplatelet drugs were investigated by a questionnaire survey.The antiplatelet therapies employed in various cardiovascular prevention strategies were compared.Univariate and multivariate logistic regression analyses were conducted to examine the factors influencing the use of antiplatelet drugs in patients with primary or secondary prevention of cardiovascular diseases.Results The atherosclerotic cardiovascular disease(ASCVD)risk assessment results of 5275 respondents showed that 952(18.0%)with extremely high risk were included in secondary prevention,1505(28.5%)with high-risk bracket and 2818(53.4%)with low and medium risks were incorporated into primary prevention.Among the 952 cases of secondary prevention,there were significant differences in the proportions of males,patients aged 80 years or older,patients with diabetes mellitus,coronary artery disease(CAD),acute myocardial infarction(AMI),operation history(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG]or carotid artery stenting[CAS]),ischemic stroke or transient ischemic attack(TIA),cognitive dysfunction,bleeding or bleeding tendency,statin users,and five or more medication between the antiplatelet drug treatment group(501 cases)and unused group(451 cases)(all P<0.05).But no significant difference was found in the proportion of patients with obesity or hypertension between the two groups(P>0.05).Among the 4323 cases of primary prevention,there were significant differences in the proportions of patients with hypertension,diabetes,dyslipidemia,obesity,the presence of three or more such factors,and patients aged 70 or above among those not advised to use antiplatelet drugs between the antiplatelet drug treatment group(369 cases)and unused group(3954 cases)(all P<0.05).However,no significant difference was found in the percentage of smokers,proportion of patients with thrombocytopenia,chronic kidney disease(CKD)disease stage 4 or 5,or those recommended for antiplatelet therapy between the two groups(P>0.05).Univariate logistic regression analysis revealed that male,age≥80 years,diabetes mellitus,CAD,AMI,operation history(PCI,CABG,or CAS),ischemic stroke or TIA,bleeding or bleeding tendency,cognitive dysfunction,use of five or more medication,and statin usage were influencing factors for antiplatelet drug use in the secondary prevention population(all P<0.05);a history of lacunar infarction,statin usage,a history or tendency of bleeding,and previous medical advice for antiplatelet therapy were influencing factors for antiplatelet drug use in the primary prevention population(all P<0.05);hypertension,diabetes mellitus,dyslipidemia,obesity,a high risk of ASCVD,age≥70 years,atrial fibrillation,a history of lacunar infarction,use of statins,and previous medical advice for antiplatelet therapy were influencing factors of no recommendation of antiplatelet therapy for primary prevention(all P<0.05).Multivariate logistic regression analysis revealed that diabetes mellitus,CAD,AMI,operation history(PCI,CABG,or CAS),ischemic stroke or TIA,bleeding or bleeding tendency,medication types≥5,and statin usage were all independent factors influencing antiplatelet drug utilization in the secondary prevention population(all P<0.05);a history of lacunar infarction,use of statins,previous medical advice for antiplatelet therapy,a history of bleeding or bleeding tendency were independent influencing factors of antiplatelet medication use in the primary prevention population(all P<0.05);moreover,hypertension,diabetes mellitus,age≥70 years,atrial fibrillation,a history of lacunar infarction,use of statins,and previous medical advice for antiplatelet therapy were identified as independent influencing factors of no recommendation of antiplatelet therapy for primary prevention population(all P<0.05).Conclusion There is a lack of standardization in the use of antiplatelet drugs for prevention of cardiovascular diseases,and there are unused and random application.Comprehensive medication guidance should be strengthened for patients of secondary prevention,especially those with bleeding history or bleeding tendency and≥5 kinds of medication.The judgement of medication indications for primary prevention and timely correction is also essential.
作者
黄双庆
徐佶佶
范虞琪
张俊峰
刘利
HUANG Shuangqing;XU Jiji;FAN Yuqi;ZHANG Junfeng;LIU Li(Department of General Practice,Songnan Town Community Health Service Center,Baoshan District,Shanghai 200434,China)
出处
《上海医学》
2024年第12期724-730,共7页
Shanghai Medical Journal
基金
上海市宝山区医学重点学(专)科及特色品牌建设计划(BSZK-2023-T04)
上海市中西医学会社区医学与健康管理科研课题(2021-49)
上海市宝山区科学技术委员会科技创新项目(19-E-15)。
关键词
心血管疾病
一级预防
二级预防
阿司匹林
抗血小板
Cardiovascular diseases
Primary prevention
Secondary prevention
Aspirin
Antiplatelet
作者简介
通信作者:徐佶佶,电子邮箱为13916799696@139.com。
