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 Relationship between Secondary Prevention Medications Adherence and Recurrent Stroke in Patients with Acute Ischemic Cerebrovascular Events

【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。 【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