冠心病和 2 型糖尿病患者在不同医疗阶段的药物治疗对比分析

M. A. Kokozheva, B. U. Mardanov, M. N. Mamedov
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引用次数: 0

摘要

目的研究各种类型的冠状动脉疾病(CAD)和 2 型糖尿病(T2D)患者在不同医疗阶段的治疗特点。对比临床研究包括 412 名急性和慢性冠状动脉疾病的男女患者。根据血糖状况和冠状动脉疾病类型,患者被分为四个亚组:亚组 1a(人数=100,56,6±0,96 岁,男女比例 67/33)--患有急性冠状动脉疾病和 T2D;亚组 1b(人数=106,58,7±1,01 岁,男女比例 75/31)--患有急性冠状动脉疾病,无 T2D;亚组 2a(n=102,57,9±1,04 岁,男/女 72/30)--患有慢性 CAD 和 T2D;亚组 2b(n=104,60,2±0,9 岁,69/35)--患有慢性 CAD,无 T2D。对标准疗法和降糖疗法的选择和平均剂量进行了分析。最初,1a 和 2a 亚组中分别有 86% 和 81% 的糖尿病患者坚持降糖治疗。在慢性冠状动脉综合征患者中,超过1/4(26.4%)的患者接受了胰岛素治疗,而在急性冠状动脉综合征(ACS)合并糖尿病患者中,只有2%的患者接受了胰岛素治疗。出院后,74% 的急性冠状动脉综合征患者和 48% 的慢性冠状动脉综合征患者接受了口服降糖药治疗。冠状动脉综合征患者的胰岛素处方增加了 5 倍(达到冠状动脉综合征和 T2D 患者总数的 10%)。入院时,分别有 70% 和 71.5% 的急性冠状动脉综合征和慢性冠状动脉综合征合并糖尿病患者服用乙酰水杨酸作为抗血小板药物。在住院期间,所有急性冠状动脉综合征患者都接受了双联抗血小板疗法,心房颤动/搏动患者还接受了三联抗血小板疗法。值得注意的是,在慢性 CAD 患者中,接受他汀类药物治疗的不到 70%。在患有慢性 CAD 和糖尿病的患者中,这一比例甚至更低,仅为 59.8%。在门诊阶段,除了无糖尿病的慢性冠状动脉粥样硬化患者外,所有患者都服用了β-受体阻滞剂(高达 65%)。在医院,β-受体阻滞剂的使用率增加到了 95%。在住院治疗期间,血管紧张素转换酶抑制剂和沙坦类药物的处方量是住院前的1.5-2倍。研究表明,标准的 CAD 和降糖治疗处方不足。住院病人谨慎选择治疗方法需要门诊阶段的连续性。
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Comparative analysis of pharmacotherapy for patients with coronary artery disease and type 2 diabetes at various healthcare stages
Aim. To study the features of treatment of patients with various types of coronary artery disease (CAD) and type 2 diabetes (T2D) at various healthcare stages.Material and methods. The comparative clinical study included 412 patients of both sexes with acute and chronic coronary artery disease. Depending on the glycemic status and CAD type, patients were divided into four subgroups: subgroup 1a (n=100, 56,6±0,96 years, male/female 67/33) — with acute CAD and T2D; subgroup 1b (n=106, 58,7±1,01 years, male/female 75/31) — with acute CAD without T2D; subgroup 2a (n=102, 57,9±1,04 years, male/female 72/30) — with chronic CAD and T2D; subgroup 2b (n=104, 60,2±0,9 years, 69/35) — with chronic CAD without T2D. The selection and mean doses of standard and hypoglycemic therapy were analyzed.Results. Initially, 86% and 81% of patients with diabetes in subgroups 1a and 2a adhered to glucose-lowering therapy. Among patients with chronic CAD, more than 1/4 (26,4%) received insulin therapy versus 2% in the group of patients with acute coronary syndrome (ACS) and diabetes. After discharge from hospital, oral hypoglycemic therapy was prescribed to 74% of patients with ACS and 48% of patients with chronic CAD. The prescription of insulin therapy for people with ACS increased 5 times (up to 10% of the total number of patients with ACS and T2D). By the time of hospital admission, 70% and 71,5% of patients with ACS and chronic CAD with diabetes received acetylsalicylic acid as an antiplatelet agent, respectively. During hospitalization, all patients with acute CAD were prescribed dual antiplatelet therapy, as well as triple antiplatelet therapy in the case of atrial fibrillation/flutter. It is noteworthy that in the group of patients with chronic CAD, less than 70% received statins. In patients with chronic CAD and diabetes, this parameter was even lower, amounting to 59,8%. At the outpatient stage, all patients, with the exception of the group with chronic CAD without diabetes, took beta-blockers (up to 65%). In the hospital, the use of beta blockers increased to 95%. During inpatient treatment, angiotensin-converting enzyme inhibitors and sartans were prescribed 1,5-2 times more often than in the prehospital stage.Conclusion. The study indicates insufficient prescription of standard CAD and glucose-lowering therapy. Careful inpatient selection of therapy requires continuity at the outpatient stage.
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来源期刊
Russian Journal of Cardiology
Russian Journal of Cardiology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
2.20
自引率
0.00%
发文量
185
审稿时长
1 months
期刊介绍: Russian Journal of Cardiology has been issued since 1996. The language of this publication is Russian, with tables of contents and abstracts of all articles presented in English as well. Editor-in-Chief: Prof. Eugene V.Shlyakhto, President of the Russian Society of Cardiology. The aim of the journal is both scientific and practical, also with referring to organizing matters of the Society. The best of all cardiologic research in Russia is submitted to the Journal. Moreover, it contains useful tips and clinical examples for practicing cardiologists. Journal is peer-reviewed, with multi-stage editing. The editorial board is presented by the leading cardiologists from different cities of Russia.
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