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目的了解中国糖尿病合并动脉粥样硬化性心血管疾病(CVD)患者他汀类药物的应用现状。方法借助1项国际多中心大规模临床试验在中国实施之际,于2007年6～12月在10个城市的39家三级医院对符合标准的高危动脉粥样硬化性CVD患者进行调查,利用电子问卷采集临床资料,对他汀类药物的使用情况进行统计描述和分析。结果调查4429例糖尿病合并动脉粥样硬化性CVD患者,年龄50～80岁,平均(64±8)岁,66.2%为男性,3345例(75.5%)合并冠心病,2053例(46.4%)合并心肌梗死,1976例(44.6%)合并缺血性脑卒中,3181例(71.8%)合并高血压。仅1952例(44.1%)患者在服用他汀类药物,其中1411例(72.3%)患者末在确诊糖尿病后立即开始服用他汀,而451例(23.1%)患者未在确诊CVD后即开始服用他汀。辛伐他汀(20mg≤且<40mg)和阿托伐他汀(10mg≤且<20mg)为最常用剂量,分别占63.5%(489/770)和61.0%(428/702)。结论目前中国糖尿病合并动脉粥样硬化性CVD患者他汀类药物的使用明显不足,应加强对医师的培训和对患者的健康宣教,努力缩小临床实践与循证医学证据和指南推荐之间的差距。
Objective To understand the status of statin use in patients with diabetes mellitus and atherosclerotic cardiovascular disease (CVD). Methods With the implementation of an international multicentre large-scale clinical trial in China, we conducted a survey of eligible high-risk atherosclerotic CVD patients at 39 tertiary hospitals in 10 cities from June to December 2007, Electronic questionnaires collected clinical data, statistics on the use of statins described and analyzed. Results A total of 4429 diabetes mellitus patients with atherosclerotic CVD were enrolled and aged 50-80 years (mean age 64 ± 8 years). 66.2% were male, 3345 (75.5%) had coronary heart disease and 2053 (46.4%) were combined Myocardial infarction, 1976 cases (44.6%) with ischemic stroke, 3181 cases (71.8%) with hypertension. Only 1952 patients (44.1%) were on statins, of whom 1411 (72.3%) had statins immediately after the diagnosis of diabetes, and 451 (23.1%) did not start taking statins after the diagnosis of CVD. Simvastatin (20 mg ≤ and <40 mg) and atorvastatin (10 mg ≤ and <20 mg) were the most commonly used dosages, accounting for 63.5% (489/770) and 61.0% (428/702), respectively. Conclusion At present, the use of statins in patients with diabetes mellitus and atherosclerotic CVD in China is obviously insufficient. Training on physicians and health education for patients should be strengthened in order to reduce the gap between clinical practice and evidence-based medical evidence and recommendation of guidelines.