缺血性脑血管病二级预防药物依从性及其影响因素研究

doi:10.3969/j.issn.1673-5765.2022.11.012

摘要/Abstract

摘要： 目的探索缺血性脑血管病患者出院后3个月二级预防药物依从性及其影响因素。
方法选取2014年1月-2018年11月任丘康济新图医院神经内科住院的急性脑梗死和TIA患者，调查其住院期间及出院后3个月服用二级预防药物的依从性，采用多因素logistic回归分析出院后3个月患者药物依从性的影响因素。
结果 4151例入组患者中，3个月随访时二级预防药物总体依从性为78.8%，在二级预防药物种类中依从性分别为抗血小板药物89.3%、降压药物87.5%、降脂药物86.9%、降糖药物79.3%、抗凝药物56.0%。多因素logistic回归分析显示，已婚（OR 1.589，95%CI 1.304～1.936，P＜0.001）、卒中病史（OR 1.225，95%CI 1.037～1.447，P=0.017）、糖尿病病史（OR 0.570，95%CI 0.463～0.701，P＜0.001）、发病前抗凝药物使用（OR 0.192，95%CI 0.060～0.619，P=0.006）、出院时二级预防药物种类数（OR 0.841，95%CI 0.736～0.960，P=0.010）为二级预防药物依从性的独立影响因素。
结论已婚、卒中病史、糖尿病病史、发病前抗凝药物使用及出院时二级预防药物种类数是二级预防药物依从性的独立影响因素。

文章导读： 本研究旨在分析缺血性脑血管病的二级预防药物依从性及其影响因素，通过回顾性研究探索影响二级预防药物依从性的独立影响因素，以指导临床采取相应干预措施，提高药物依从性，降低缺血性脑血管病的复发风险。

关键词: 缺血性脑血管病; 药物依从性; 二级预防

Abstract: Objective To analyze the adherence of secondary prevention drugs within 3 months after discharge and related influencing factors in patients with ischemic cerebrovascular disease.
Methods The patients with acute cerebral infarction and TIA hospitalized in Department of Neurology of Renqiu Kangji Xintu Hospital from January 2014 to November 2018 were included in the retrospective analysis. The adherence of drugs during hospitalization and 3 months after discharge were analyzed. Multivariate logistic regression analysis was used to determine the influencing factors of drug adherence.
Results A total of 4151 patients were included in this study. The total adherence rate of secondary prevention drugs at 3 months after discharge was 78.8%, and that of all kinds of secondary prevention drugs were as follows: antiplatelet drugs was 89.3%, antihypertensive drugs was 87.5%, lipid-lowering drugs was 86.9% and hypoglycemic drugs was 79.3% and anticoagulants was 56.0%. Multivariate logistic regression analysis showed that being married (OR 1.589, 95%CI 1.304-1.936, P<0.001), history of stroke (OR 1.225, 95%CI 1.037-1.447, P=0.017), history of diabetes (OR 0.570, 95%CI 0.463-0.701, P<0.001) and anticoagulant drug use before stroke or TIA onset (OR 0.192, 95%CI 0.060-0.619, P=0.006), number of drug kinds prescribed at discharge (OR 0.841, 95%CI 0.736-0.960, P=0.010) were independent influencing factors of drug adherence.
Conclusions Being married, history of stroke, history of diabetes, use of anticoagulants before stroke or TIA onset and number of drug kinds prescribed at discharge were independent influencing factors of secondary prevention drug adherence for patients with ischemic stroke or TIA.

Key words: Ischemic cerebrovascular disease; Drug adherence; Secondary prevention

杨红娜, 冀瑞俊, 于凯, 何艳, 徐丽华, 王拥军. 缺血性脑血管病二级预防药物依从性及其影响因素研究 [J]. 中国卒中杂志, 2022, 17(11): 1227-1232.

YANG Hongna, JI Ruijun, YU Kai, HE Yan, XU Lihua, WANG Yongjun. Drug Adherence and Influencing Factors in Secondary Prevention of Ischemic Cerebrovascular Disease [J]. Chinese Journal of Stroke, 2022, 17(11): 1227-1232.

参考文献

[1] GUDKOVA V V，STAKHOVSKAIA L V，SHANINA T V，et al. The antithrombotic treatment in the secondary prevention of ischemic stroke：strategy and tactic issues[J]. Zh Nevrol Psikhiatr Im S S Korsakova，2011，111（11Pt1）：87-94.
[2] 姜悦，王晨，李子孝，等. 不同等级医院缺血性脑血管病二级预防药物依从性研究[J]. 临床药物治疗杂志，2019，17（8）：35-39.
[3] FORD E S，AJANI U A，CROFT J B，et al. Explaining the decrease in US deaths from coronary disease，1980-2000[J]. N Engl J Med，2007，356（23）：2388-2398.
[4] LABUZ R B，STAROSTKA T A，LASEK B A，et al. Diagnostics，treatment and secondary prevention of ischemic stroke in the Silesian Province，Poland between 2009 and 2015[J]. Neurol Neurochir Pol，2018，52（2）：235-242.
[5] HEIT J J，WINTERMARK M. New developments in clinical ischemic stroke prevention and treatment and their imaging implications[J]. J Cereb Blood Flow Metab，2018，38（9）：1533-1550.
[6] 李文健，潘旭东，王静，等. 缺血性脑卒中后二级预防药物依从性现状及对预后的影响[J]. 中华神经科杂志，2017，50（3）：178-183.
[7] MURPHY S J，COUGHLAN C A，TOBIN O，et al. Continuation and adherence rates on initially-prescribed intensive secondary prevention therapy after rapid access stroke prevention（RASP） service assessment[J]. J Neurol Sci，2016，361（15）：13-18.
[8] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010[J]. 中华神经科杂志，2010，43（2）：146-153.
[9] JI R J，LIU G F，SHEN H P，et al. Persistence of secondary prevention medications after acute ischemic stroke or transient ischemic attack in Chinese population：data from China National Stroke Registry[J]. Neurol Res，2013，35（1）：29-36.
[10] 徐翠萍，祝美蓉，罗锐，等. 成都市龙泉驿区脑梗死患者二级预防现状[J]. 中国神经精神疾病杂志，2013，39（12）：729-732.
[11] BUSHNELL C D，ZIMMER L O，PAN W，et al. Persistence with stroke prevention medications 3 months after hospitalization[J]. Arch Neurol，2010，67（12）：1456-1463.
[12] 陈艳雪，姜悦，李子孝，等. 中国急性缺血性卒中及短暂性脑缺血发作二级预防药物依从性的现状[J]. 中国卒中杂志，2018，13（7）：686-691.
[13] WEI W J，WANG J G，HUANG Y，et al. Secondary prevention of ischemic stroke in urban China[J]. Stroke，2010，41（5）：967-974.
[14] 孟霞，张星，吕微，等. 缺血性脑血管病二级预防药物依从性与卒中复发的关系研究[J]. 中国卒中杂志，2019，14（7）：653-659.
[15] YUE J，YANG X M，LI Z X，et al. Persistence of secondary prevention medication and related factors for acute ischemic stroke and transient ischemic attack in China[J]. Neurol Res，2017，39（6）：492-497.
[16] 徐洁，谭盛. 缺血性脑卒中及短暂性脑缺血发作患者二级预防用药依从性的现状研究[J]. 实用医学杂志，2016，32（13）：2095-2098.
[17] RUDD A G，LOWE D，HOFFMAN A，et al. Secondary prevention for stroke in the United Kingdom：results from the national sentinelaudit of Stroke[J]. Age Ageing，2004，33（12）：280-286.
[18] 万志荣，何向楠，李继来，等. 不同等级医院缺血性脑卒中患者二级预防用药依从性现状研究[J]. 中国医药科学，2014，4（3）：77-89.
[19] 孙艺红，胡大一. 非瓣膜病心房颤动患者全球抗凝注册研究中国亚组基线数据分析[J]. 中华心血管病杂志，2014，42（10）：846-850.
[20] SHAYA F，DU D，GBARAYOR C，et al. Predictors of compliance with anti-hypertensive therapy in a high-risk medicaid population[J]. J Natl Med Assoc，2009，101（1）：34-39.