方华 张高峰 王娜 李洁 沈颖 郑俊婷 单知农 史佳音

摘 要 目的：了解上海某社區动脉粥样硬化性心血管病（ASCVD）高危人群预防性用药的情况以及影响因素。方法：来自古美社区卫生服务中心慢病管理平台2018年完成建档、且资料完整的60岁及以上的ASCVD高危对象（10年心血管病发病危险为10%～15%）1 141例，其中男性496例，女性645例，年龄为63～81岁，平均年龄（72.4±4.7）岁。通过电子处方系统获取该人群近1年内的药物治疗情况。经电话访谈确认相关信息。结果：抗血栓药物服用比例为40.5%，糖尿病、LDL-c达标、无规则运动的人群的服用比例较高（P<0.05）。他汀类药物服用比例为43.5%，LDL-c达标和无规律运动人群的服药比例较高（P<0.05）。logistic回归分析显示，LDL-c未达标、吸烟和规律运动是不服用抗血栓药物的影响因素（P<0.05）；LDL-c未达标和规律运动是不服用他汀类药物的影响因素（P<0.05）。结论：社区ASCVD高危人群中应用抗血栓药物和他汀类药物的比例偏低，与LDL-c不达标及运动习惯相关。需要进一步加强预防性用药的宣教和推广。

关键词 动脉粥样硬化性血管疾病；高危人群；指南导向药物治疗；调查

中图分类号：R714.252 文献标志码：A 文章编号：1006-1533（2021）10-0034-03

A survey of guideline directed prophylactic drug use among high risk population of atherosclerotic cardiovascular disease in a community of Shanghai

FANG Hua1， ZHANG Gaofeng2， WANG Na3， LI Jie1， SHEN Ying1， ZHENG Junting1， SHAN Zhinong1， SHI Jiayin1

（1. General Practice Department of Gumei Community Health Service Center of Minhang District， Shanghai 201102， China； 2. Department of Cardiology of Shanghai Fifth Peoples Hospital， and Center of Community-Based Health Research Affiliated to Fudan University， Shanghai 200240， China； 3. Public Health School of Fudan University， Shanghai， 200032， China）

ABSTRACT Objective： To investigate the situation and influencing factors of prophylactic drug use among highrisk population of atherosclerotic cardiovascular disease（ASCVD） in a community of Shanghai. Methods： From the chronic disease management platform of the Gumei Community Health Service Center in 2018， there were 1 141 cases of ASCVD highrisk subjects（10-year cardiovascular disease risk 10%～15%） who were 60 years old and above with complete documentation and complete data. Among them， there were 496 males and 645 females， aged from 63 to 81 years old， with an average age of （72.4±4.7） years old. Through the electronic prescription system the drug treatment of this population in the past year was obtained. The relevant information was confirmed through telephone interview. Results： The proportion of taking antithrombotic drugs was 40.5%， and the proportion of people with diabetes， LDL-c up to standard and irregular exercise was higher（P<0.05）. The proportion of statins taken was 43.5%， LDL-c compliance and irregular exercise group had a higher proportion of taking medication（P<0.05）. Logistic regression analysis showed that LDL-c failure， smoking and regular exercise were the influencing factors of not taking antithrombotic drugs（P<0.05）； LDL-c failure and regular exercise were the influencing factors of not taking statins（P<0.05）. Conclusion： The low proportion of antithrombotic drugs and statins used in community ASCVD high-risk populations is related to LDL-c failure and exercise habits. It is necessary to further strengthen the propaganda and promotion of preventive drug use.

KEY WORDS atherosclerotic cardiovascular disease； high risk people； guideline directed medical therapy； investigation

目前我国人群最大的疾病负担是动脉粥样硬化性心血管疾病（atherosclerotic cardiovascular disease，ASCVD）。ASCVD主要包括缺血性心脏病和缺血性脑卒中。因两者在病因学、病理机制和预防策略上具有极大的共性，国内外相关防治指南趋于将二者视为一种疾病进行综合防治。有研究显示，我国心血管疾病死亡和在总死亡中的占比分别从1990年时的40%和11%上升到2016年的61%和25%；同期的死亡人数从100万/年增加到240万/年[1]。近期调查结果显示，我国约有11.1%的成人为心血管疾病的高危或极高危人群[2]。对ASCVD高危人群人群的药物治疗能够有效预防和降低ASCVD的发病率、致残率和致死率。中国心血管病预防指南根据ASCVD发病风险将人群分成不同危險组，并针对不同危险人群推荐相应的综合治疗方案，包括血压、血糖和血脂控制目标以及他汀类和小剂量阿司匹林的应用[3]。……