β-受体阻滞剂在新疆地区维吾尔族和汉族冠心病患者中的使用情况及静息心率达标情况研究
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摘要
背景β-受体阻滞剂能显著改善冠心病的临床症状,缓解心绞痛的发生,降低全因死亡率。新疆地区不同民族之间在冠心病病变程度、危险因素等方面存在差异,在两个民族之间,临床用药的不同也应引起重视。目的调查新疆地区维吾尔族和汉族冠心病患者β-受体阻滞剂使用情况及静息心率达标情况,并探讨其影响因素。方法选择2016年12月—2017年3月石河子大学医学院第一附属医院住院的812例冠心病患者,维吾尔族140例(17.24%),汉族672例(82.76%),记录患者入院时一般临床资料,服用β-受体阻滞剂例数,行冠状动脉造影、血运重建的比例,冠状动脉病变支数,记录入院及出院时静息心率,出院时静息心率达标情况。采用多因素Logistic回归分析服用β-受体阻滞剂及静息心率达标的影响因素。随访6个月,记录患者继续服药率及停药原因。结果维吾尔族冠心病患者年龄、出院时静息心率达标率较汉族低,体质指数(BMI)、合并高血压、心肌梗死、心力衰竭比例、低密度脂蛋白水平、冠状动脉造影、血运重建的比例、冠状动脉病变支数、入院和出院时静息心率较汉族升高(P<0.05)。多因素Logistic回归模型结果显示,年龄[OR=8.924,95%CI(5.483,14.525)]、吸烟[OR=2.014,95%CI(1.412,2.873)]、高血压[OR=1.697,95%CI(1.183,2.436)]、心肌梗死[OR=1.418,95%CI(0.994,2.022)]、心力衰竭[OR=1.661,95%CI(1.155,2.388)]、糖尿病[OR=2.175,95%CI(1.497,3.160)]、冠状动脉造影[OR=1.887,95%CI(1.320,2.696)]、血运重建[OR=2.080,95%CI(1.376,3.145)]、冠状动脉病变支数[OR=0.159,95%CI(0.070,0.359)]是服用β-受体阻滞剂的影响因素(P<0.05);年龄[OR=2.069,95%CI(1.173,3.649)]、民族[OR=0.292,95%CI(0.196,0.433)]、心肌梗死[OR=1.918,95%CI(1.357,2.710)]是静息心率达标的影响因素(P<0.05)。随访6个月,维吾尔族和汉族冠心病患者继续服药率分别为89.29%(125/140)、93.78%(618/659)。结论维吾尔族和汉族冠心病患者服用β-受体阻滞剂比例均较低;维吾尔族冠心病患者虽然服用β-受体阻滞剂比例较汉族高,但是静息心率较快、静息心率达标率偏低,这就要求临床医生应加强对维吾尔族冠心病患者β-受体阻滞剂的使用。
Background Beta blockers can improve clinical symptoms of coronary heart disease(CHD),relieve the incidence of angina pectoris and reduce all-cause mortality in patients.Lesion degree and risk factors of CHD show differences in Uygur and Chinese Han patients.Between two ethnic groups,the difference in clinical medication should also be taken seriously.Objective To investigate the usage of beta blockers and resting heart rate(RHR) controlling status in Uygur and Chinese Han patients with CHD in Xinjiang,and to explore its influencing factors.Methods A total of 812 patients [140 Uyghur(17.24 %) and 672 Chinese Han(82.76 %)],diagnosed with CHD and hospitalized in the First Affiliated Hospital of the Medical College,Shihezi University from December 2016 to March 2017 were enrolled and followed up for six months.Data of general clinical information,coronary arteriography,revascularization,characteristics of coronary lesions,the usage,types and dosage of beta blockers,RHR at admission and discharge,controlling rate of RHR,and the rate of compliance and the causes of the drug withdrawal were collected and recorded.Factors influencing beta blockers-taking compliance and controlling rate of RHR were analyzed with multivariate Logistic regression analysis.Results Compared to Chinese Han patients with CHD,Uygur patients are significantly younger and they displayed larger body mass index(BMI),lower controlling rate of RHR,higher low density lipoprotein level,higher rate of coronary arteriography and revascularization,combined with other diseases including hypertension,heart failure,myocardial infarction and multi-vessel lesion,with higher RHR at admission and discharge(P<0.05).In addition,the results of multivariate Logistic regression analysis showed that age [OR=8.924,95%CI(5.483,14.525)],smoking [OR=2.014,95%CI(1.412,2.873)],hypertension [OR=1.697,95%CI(1.183,2.436)],myocardial infarction [OR=1.418,95%CI(0.994,2.022)],heart failure [OR=1.661,95%CI(1.155,2.388)],diabetes mellitus [OR=2.175,95%CI(1.497,3.160)],coronary angiography [OR=1.887,95%CI(1.320,2.696)],revascularization [OR=2.080,95%CI(1.376,3.145)],the number of involved coronary lesions [OR=0.159,95%CI(0.070,0.359)] were related to higher taking rate of beta blockers(P<0.05).Factors influencing the controlling rate of RHR included age [OR=2.069,95%CI(1.173,3.649)],nationality [OR=0.292,95%CI(0.196,0.433)],myocardial infarction [OR=1.918,95%CI(1.357,2.710)].After a 6-month follow-up,the compliance rates were 89.29%(125/140) and 93.78%(618/659) among Uyghur and Chinese Han patients,respectively.Conclusion Both Uygur and Chinese Han patients with CHD had low taking rate of beta blockers.Although Uygur patients had higher proportion of taking beta blockers than Chinese Han patients,they had faster RHR and lower controlling rate of RHR,which requires clinicians to improve the usage of beta blockers in Uygur patients with CHD.
Background Beta blockers can improve clinical symptoms of coronary heart disease(CHD),relieve the incidence of angina pectoris and reduce all-cause mortality in patients.Lesion degree and risk factors of CHD show differences in Uygur and Chinese Han patients.Between two ethnic groups,the difference in clinical medication should also be taken seriously.Objective To investigate the usage of beta blockers and resting heart rate(RHR) controlling status in Uygur and Chinese Han patients with CHD in Xinjiang,and to explore its influencing factors.Methods A total of 812 patients [140 Uyghur(17.24 %) and 672 Chinese Han(82.76 %)],diagnosed with CHD and hospitalized in the First Affiliated Hospital of the Medical College,Shihezi University from December 2016 to March 2017 were enrolled and followed up for six months.Data of general clinical information,coronary arteriography,revascularization,characteristics of coronary lesions,the usage,types and dosage of beta blockers,RHR at admission and discharge,controlling rate of RHR,and the rate of compliance and the causes of the drug withdrawal were collected and recorded.Factors influencing beta blockers-taking compliance and controlling rate of RHR were analyzed with multivariate Logistic regression analysis.Results Compared to Chinese Han patients with CHD,Uygur patients are significantly younger and they displayed larger body mass index(BMI),lower controlling rate of RHR,higher low density lipoprotein level,higher rate of coronary arteriography and revascularization,combined with other diseases including hypertension,heart failure,myocardial infarction and multi-vessel lesion,with higher RHR at admission and discharge(P<0.05).In addition,the results of multivariate Logistic regression analysis showed that age [OR=8.924,95%CI(5.483,14.525)],smoking [OR=2.014,95%CI(1.412,2.873)],hypertension [OR=1.697,95%CI(1.183,2.436)],myocardial infarction [OR=1.418,95%CI(0.994,2.022)],heart failure [OR=1.661,95%CI(1.155,2.388)],diabetes mellitus [OR=2.175,95%CI(1.497,3.160)],coronary angiography [OR=1.887,95%CI(1.320,2.696)],revascularization [OR=2.080,95%CI(1.376,3.145)],the number of involved coronary lesions [OR=0.159,95%CI(0.070,0.359)] were related to higher taking rate of beta blockers(P<0.05).Factors influencing the controlling rate of RHR included age [OR=2.069,95%CI(1.173,3.649)],nationality [OR=0.292,95%CI(0.196,0.433)],myocardial infarction [OR=1.918,95%CI(1.357,2.710)].After a 6-month follow-up,the compliance rates were 89.29%(125/140) and 93.78%(618/659) among Uyghur and Chinese Han patients,respectively.Conclusion Both Uygur and Chinese Han patients with CHD had low taking rate of beta blockers.Although Uygur patients had higher proportion of taking beta blockers than Chinese Han patients,they had faster RHR and lower controlling rate of RHR,which requires clinicians to improve the usage of beta blockers in Uygur patients with CHD.
引文
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[8]罗仁,茶春喜,姚建平.维吾尔族与汉族早发冠心病患者冠状动脉病变的临床研究[J].中华实用诊断与治疗杂志,2009,23(6):548-550.LUO R,CHA C X,YAO J P.Clinical study on coronary artery lesion between Han and Uygur nationality patients with premature coronary artery diseas[J].Journal of Chinese Practical Diagnosis and Therapy,2009,23(6):548-550.
[9]邢艳,潘存雪,刘文亚,等.维吾尔族、汉族冠状动脉斑块64排螺旋CT特征与危险因素对照分析[J].中华实用诊断与治疗杂志,2011,25(4):340-343.XING Y,PAN C X,LIU W Y,et al.Comparison between the characteristics of coronary plaque by 64-slice CT and risk factors in Uygur and Han patients in Xinjiang[J].Journal of Chinese Practical Diagnosis and Therapy,2011,25(4):340-343.
[10]ZACHARIAH D,BROWN R,KANAGALA P,et al.The impact of age and chronic kidney disease on secondary prevention postprimary percutaneous coronary intervention[J].QJM,2014,107(3):185-192.DOI:10.1093/qjmed/hct222.
[11]American College of Emergency Physicians,Society for Cardiovascular Angiography and Interventions,O'GARA P T,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,61(4):485-510.DOI:10.1016/j.jacc.2012.11.018.
[12]杨俊敏,黄淑田,李杰,等.β受体阻滞剂在冠心病临床应用分析研究[J].中国心血管病研究,2017,15(5):463-466.DOI:10.3969/j.issn.1672-5301.2017.05.021.YANG J M,HUANG S T,LI J,et al.Analytical research ofβreceptor blockers'clinical application in patients with coronary heart disease[J].Chinese Journal of Cardiovascular Research,2017,15(5):463-466.DOI:10.3969/j.issn.1672-5301.2017.05.021.
[2]方晗,程晋芳,倪国华,等.冠心病患者静息心率达标情况及β-受体阻滞剂使用情况的现况调查[J].临床心血管病杂志,2011,27(3):190-192,197.DOI:10.3969/j.issn.1001-1439.2011.03.012.FANG H,CHENG J F,NI G H,et al.A cross-sectional study on successful rate of resting heart rate in coronary heart disease patients administratingβ-blockers orally[J].Journal of Clinical Cardiology,2011,27(3):190-192,197.DOI:10.3969/j.issn.1001-1439.2011.03.012.
[3]STEPINSKA J,MARONA M,GREENLAW N,et al.Heart rate and the use of beta-blockers in stable outpatients with coronary artery disease:polish baseline results of the CLARIFY registry[J].Kardiol Pol,2014,72(11):1156-1164.DOI:10.5603/KP.a2014.0134.
[4]蒋捷,王新刚,贾佳,等.β受体阻滞剂在中国稳定性心绞痛患者中的使用及其影响因素[J].中华心血管病杂志,2015,43(3):227-233.DOI:10.3760/cma.j.issn.0253-3758.2015.03.009.JIANG J,WANG X G,JIA J,et al.Current status and influence factors of beta blocker prescription in Chinese patients with stable angina pectoris[J].Chinese Journal of Cardiology,2015,43(3):227-233.DOI:10.3760/cma.j.issn.0253-3758.2015.03.009.
[5]LI J,LI X,WANG Q,et al.ST-segment elevation myocardial infarction in China from 2001 to 2011(the China PEACE-Retrospective Acute Myocardial Infarction Study):a retrospective analysis of hospital data[J].Lancet,2015,385(9966):441.DOI:10.1016/S0140-6736(14)60921-1.
[6]KIRTANE A J,STONE G W.STEMI care in China:a world opportunity[J].Lancet,2015,385(9966):400-401.DOI:10.1016/S0140-6736(14)61033-3.
[7]刘浩,翟雪芹,王晓峰.维吾尔族和汉族早发冠心病危险因素及中医证型对比研究[J].中西医结合心脑血管病杂志,2012,10(1):1-3.DOI:10.3969/j.issn.1672-1349.2012.01.001.LIU H,ZHAI X Q,WANG X F.Comparison of risk factors and TCMsyndrome in premature coronary heart disease between Uygur Race and Han Race[J].Chinese Journal of Integrative Medicine on Cardio/Cerebrovascuiar Disease,2012,10(1):1-3.DOI:10.3969/j.issn.1672-1349.2012.01.001.
[8]罗仁,茶春喜,姚建平.维吾尔族与汉族早发冠心病患者冠状动脉病变的临床研究[J].中华实用诊断与治疗杂志,2009,23(6):548-550.LUO R,CHA C X,YAO J P.Clinical study on coronary artery lesion between Han and Uygur nationality patients with premature coronary artery diseas[J].Journal of Chinese Practical Diagnosis and Therapy,2009,23(6):548-550.
[9]邢艳,潘存雪,刘文亚,等.维吾尔族、汉族冠状动脉斑块64排螺旋CT特征与危险因素对照分析[J].中华实用诊断与治疗杂志,2011,25(4):340-343.XING Y,PAN C X,LIU W Y,et al.Comparison between the characteristics of coronary plaque by 64-slice CT and risk factors in Uygur and Han patients in Xinjiang[J].Journal of Chinese Practical Diagnosis and Therapy,2011,25(4):340-343.
[10]ZACHARIAH D,BROWN R,KANAGALA P,et al.The impact of age and chronic kidney disease on secondary prevention postprimary percutaneous coronary intervention[J].QJM,2014,107(3):185-192.DOI:10.1093/qjmed/hct222.
[11]American College of Emergency Physicians,Society for Cardiovascular Angiography and Interventions,O'GARA P T,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,61(4):485-510.DOI:10.1016/j.jacc.2012.11.018.
[12]杨俊敏,黄淑田,李杰,等.β受体阻滞剂在冠心病临床应用分析研究[J].中国心血管病研究,2017,15(5):463-466.DOI:10.3969/j.issn.1672-5301.2017.05.021.YANG J M,HUANG S T,LI J,et al.Analytical research ofβreceptor blockers'clinical application in patients with coronary heart disease[J].Chinese Journal of Cardiovascular Research,2017,15(5):463-466.DOI:10.3969/j.issn.1672-5301.2017.05.021.