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

doi:10.3969/j.issn.1673-5765.2019.07.005

摘要/Abstract

摘要：

目的调查中国缺血性脑血管病患者二级预防药物依从性的现状，探讨急性缺血性脑血管病患者 3个月二级预防药物的依从性与1年卒中复发的关系。方法研究纳入18岁以上的首发急性缺血性卒中或TIA患者。药物依从性被定义为随访期间规律服用所有出院时所带的二级预防药物。采用多变量Logistic回归分析出院3个月二级预防药物依从性的影响因素及出院3个月药物依从性与1年卒中复发之间的关系。结果研究共纳入2768例病例，平均年龄为（62.3±11.4）岁，女性988例（35.7％）。3个月随访时，药物依从者2016例（72.8%），非依从性者752例（27.2%），药物依从性最高的是抗血小板药物（95.3％），随后是降糖药物（90.9％）、降压药（90.2％）和降脂药物（85.4％），抗凝药的依从性最低（73％）。糖尿病史（OR 1.40，95%CI 1.14～1.73，P =0.0016）和降糖药物使用史（OR 1.43，95%CI 1.14～1.79，P =0.0022）可能是药物依从性的影响因素，但校正年龄、性别后两者对药物依从性的影响均无统计学意义。校正年龄、性别、医保类型、吸烟、疾病史、家族史等混杂因素后，Logistic回归结果显示3个月二级预防药物依从性是出院1年的卒中复发率降低的独立影响因素（OR 0.36，95％CI 0.14～0.91，P =0.0301）。结论急性缺血性脑血管病患者3个月药物依从性良好是1年卒中复发率降低的独立影响因素。

文章导读： 本研究调查了中国缺血性脑血管病患者3个月药物依从性的现状及其与1年卒中复发的关系，结果提示3个
月药物依从性良好是1年卒中复发率降低的独立影响因素。

关键词: 依从性; 二级预防药物; 卒中复发; 急性缺血性脑血管病

Abstract:

Objective To investigate the status of secondary prevention medications adherence in patients with ischemic cerebrovascular diseases in China, and the relationship between 3-month medication adherence and 1-year recurrent stroke after discharge in patients with acute ischemic stroke or TIA. Methods Patients diagnosed with first-ever acute ischemic stroke or TIA from Stroke and Transient Ischemic Stroke Treatment Adherence Registry in China were enrolled in this study. Medication adherence was defined as taking all secondary prevention medications prescribed at discharge continuously and regularly during the 3-month follow up. Multivariate logistic regression analysis was used to analyze the relationship between 3-month medications persistence and 1-year recurrent stroke after discharge. Results A total of 2768 patients were selected, with the mean age 62.3±11.4 years and 988 (35.7%) female patients. 2016 patients (72.8%) persisted in taking all secondary prevention medications during the 3-month follow up; the drug adherence rate were 95.3%, 90.9%, 90.2%, 85.4% and 73% for antiplatelet agents, blood glucose-lowering drugs, antihypertensive drugs, lipid-lowering drugs, and anticoagulation agents, respectively. The diabetes history (OR 1.40, 95%CI 1.14-1.73,P =0.0016) and the cessation history of blood glucose-lowering drugs might be the influence factors for drugs adherence, while there were no statistical significance after adjusting for the confounding factors. After adjusting for the confounders including age, sex, medical history and so on, logistic regression analysis showed 3-month persistence of secondary prevention medications was an independent influence factor for recurrent stroke at 1 year after discharge (OR 0.36, 95%CI 0.14- 0.91, P =0.0301). Conclusions The 3-month persistence of secondary prevention drugs was much more satisfactory compared to the previous results reported in Chinese patients. The 3-month persistence of secondary prevention medications was an independent influence factor for recurrent stroke at 1 year after discharge.

Key words: Persistence; Secondary prevention medication; Recurrent stroke; Ischemic cerebrovascular disease

孟霞，张星，吕微，张心邈，荆京，谷鸿秋. 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(07): 653-659.

MENG Xia, ZHANG Xing, LYU Wei, ZHANG Xin-Miao, JING Jing, GU Hong-Qiu. Relationship between Secondary Prevention Medications Adherence and Recurrent Stroke in Patients with Acute Ischemic Cerebrovascular Events[J]. Chinese Journal of Stroke, 2019, 14(07): 653-659.

参考文献

[1] FEIGIN V，MENSAH G，NORRVING B，et al.

Atlas of the Global Burden of Stroke（1990-2013）：

the GBD 2013 study[J]. Neuroepidemiology，2015，

45（3）：230-236.

[2] WANG W，JIANG B，SUN H，et al. Prevalence，

incidence，and mortality of stroke in China：results

from a nationwide population-based survey of

480 687 adults[J]. Circulation，2017，135（28）：759-

771.

[3] SHAYA F T，EL KHOURY A C，MULLINS C D，et

al. Drug therapy persistence and stroke recurrence[J].

Am J Manag Care，2006，12（6）：313-319.

[4] HANKEY G，JAMROZIK K，BROADHURST R，

et al. Long-term risk of first recurrent stroke in the

Perth Community Stroke Study[J]. Stroke，1998，29

（12）：2491-500.

[5] XU J，ZHAO X，WANG Y，et al. Impact of a better

persistence with antihypertensive agents on ischemic

stroke outcomes for secondary prevention[J/OL].

PLoS One，2013，8（6）：e65233. https：//doi.

org/10.1371/journal.pone.0065233.

[6] OVBIAGELE B，CAMPBELL S，FAIZ A，et al.

Relationship between non-specific prescription

pill adherence and ischemic stroke outcomes[J].

Cerebrovas Dis，2010，29（2）：146-153.

[7] BURKE J P，SANDER S，SHAH H，et al. Impact

of persistence with antiplatelet therapy on recurrent

ischemic stroke and predictors of nonpersistence

among ischemic stroke survivors[J]. Curr Med Res

Opin，2010，26（5）：1023-1030.

[8] WHO MONICA Project Principal Investigators.

The World Health Organization MONICA

Project（monitoring trends and determinants in

cardiovascular disease）：a major international

collaboration. WHO MONICA Project Principal

Investigators[J]. J Clin Epidemiol，1988，41（2）：105-114.

[9] SAPPOK T，FAULSTICH A，STUCKERT E，et al.

Compliance with secondary prevention of ischemic

stroke：a prospective evaluation[J]. Stroke，2001，32

（8）：1884-1889.

[10] OVBIAGELE B，KIDWELL C S，SELCO S，et al.

Treatment adherence rates one year after initiation

of a systematic hospital-based stroke prevention

program[J]. Cerebrovasc Dis，2005，20（4）：280-

282.

[11] BUSHNELL C，ZIMMER L，PAN W，et al.

Persistence with stroke prevention medications 3

months after hospitalization[J]. Arch. Neurol，2010，

67（2）：1456-1463.

[12] BUSHNELL C，OLSON D，ZHAO X，et al.

Secondary preventive medication persistence and

adherence 1 year after stroke[J]. Neurology，2011，77

（12）：1182-1190.

[13] WEI J，WANG J，HUANG Y，et al. Secondary

prevention of ischemic stroke in urban China[J].

Stroke，2010，41（5）：967-974.

[14] JI R，LIU G，SHEN H，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.

[15] 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（6）：686-691.

[16] JAMISON J，GRAFFY J，MULLIS R，et al.

Barriers to medication adherence for the secondary

prevention of stroke：a qualitative interview study

in primary care[J]. Br J Gen Pract，2016，66（649）：

e568-e576.

[17] LOVETT J K，COULL A J，ROTHWELL P M.

Early risk of recurrence by subtype of ischemic

stroke in population-based incidence studies[J].

Neurology，2004，62（4）：569-573.

[18] KLEINDORFER D，PANAGOS P，PANCIOLI A，

et al. Incidence and short-term prognosis of transient

ischemic attack in a population-based study[J].

Stroke，2005，36（4）：720-723.

[19] JOHNSTON S C，GRESS D R，BROWNER W S，et

al. Short-term prognosis after emergency department

diagnosis of TIA[J]. Jama，2000，284（22）：2901-

2906.

[20] OVBIAGELE B，CAMPBELL S，FAIZ A，et al.

Relationship between non-specific prescription

pill adherence and ischemic stroke outcomes[J].

Cerebrovasc Dis，2010，29（2）：146-153.

[21] OVBIAGELE B，SAVER J L，FREDIEU A，et al.

In-hospital initiation of secondary stroke prevention

therapies yields high rates of adherence at followup[

J]. Stroke，2004，35（12）：2879-2883.

[22] KIM J，LEE H S，NAM C M，et al. Effects of statin

intensity and adherence on the long-term prognosis

after acute ischemic stroke[J]. Stroke，2017，48（10）：

2723-2730.