文章摘要
白旭,宋艳平,吕芯芮,饶夫阳,覃伟,黄馨莹,李子孝,刘宝花,姜勇.急性缺血性卒中患者早期抗栓治疗影响因素的多水平模型分析[J].中华流行病学杂志,2019,40(6):610-615
急性缺血性卒中患者早期抗栓治疗影响因素的多水平模型分析
Multi-level analysis on factors affecting the adherence to early antithrombotic therapy among people with acute ischemic stroke
投稿时间:2019-01-19  
DOI:10.3760/cma.j.issn.0254-6450.2019.06.002
中文关键词: 急性缺血性卒中;早期抗栓治疗;多水平模型
英文关键词: Acute ischemic stroke;Antithrombotic therapy;Multilevel model
基金项目:国家重点研发计划精准医学研究专项(2016YFC0901000,2016YFC0901001);国家重点研发计划重大慢性非传染性疾病防控研究专项(2018YFC1311703)
作者单位E-mail
白旭 北京大学公共卫生学院 100191  
宋艳平 北京大学公共卫生学院 100191  
吕芯芮 北京大学公共卫生学院 100191  
饶夫阳 北京大学公共卫生学院 100191  
覃伟 北京大学公共卫生学院 100191  
黄馨莹 首都医科大学附属北京天坛医院 国家神经系统疾病临床医学研究中心, 北京 100070  
李子孝 首都医科大学附属北京天坛医院 国家神经系统疾病临床医学研究中心, 北京 100070  
刘宝花 北京大学公共卫生学院 100191 baohualiu@bjmu.edu.cn 
姜勇 首都医科大学附属北京天坛医院 国家神经系统疾病临床医学研究中心, 北京 100070 jiangyong@ncrcnd.org.cn 
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中文摘要:
      目的 探索影响急性缺血性卒中(AIS)患者早期抗栓治疗实施的影响因素,为促进早期抗栓治疗提供参考。方法 选取中国国家卒中登记Ⅱ(CNSR Ⅱ)研究中符合早期抗栓治疗条件的≥50岁AIS患者,收集患者及医院信息。对医院和患者因素与是否进行早期抗栓治疗进行单因素分析。以患者水平为水平1,医院水平为水平2,建立两水平logistic回归模型,分析医院和患者因素对是否进行早期抗栓治疗的影响。结果 共纳入16 910例患者,其中有14 332例(84.75%)接受了早期抗栓治疗。单因素分析结果显示,早期抗栓治疗的患者相关因素包括年龄、医保类型、家庭人均月收入、血脂异常病史;医院相关因素包括医院级别、医院所在地区、是否为教学医院、是否有卒中单元、实行单病种质量控制、神经科床位数比例(P<0.05)。多水平模型显示,早期抗栓治疗的患者相关因素包括性别、年龄、家庭人均月收入、高血压病史、入院美国国立卫生研究院卒中量表(NIHSS)评分;医院相关因素包括神经科床位数比例和医院所在地区(P<0.05)。结论 早期抗栓治疗实施与医院医疗水平相关,应对高龄和入院NIHSS评分高的AIS患者进行重点关注。
英文摘要:
      Objective To explore the patient and hospital related determinants of adherence to early antithrombotic therapy among patients with acute ischemic stroke (AIS). Methods AIS patients aged 50 years old or above who were eligible for early antithrombotic therapy, were included from the China National Stroke Registry Ⅱ (CNSR Ⅱ) project. Characteristics related to patients and hospitals were collected. Univariate analysis method was conducted to explore the correlation between hospital or patient-related determinants and early antithrombotic therapy. A 2-level logistic regression model was set up to identify patient and hospital-related variables that were associated with the adherence to early antithrombotic therapy, with patient as level 1 and hospital as level 2. Results A total of 16 910 patients were included in the study, with 14 332 (84.75%) of them having received early antithrombotic therapy. Results from the univariate analysis showed that the patient determinants to early antithrombotic therapy would include age, type of health insurance, average income and history of dyslipidemia. Hospital determinants would include factors as:level and region of the hospital, academic status, with/without stroke unit, quality control on single disease and the percentage of neurological beds in total beds (P<0.05). Data on multilevel model showed that the patient-related determinants on early antithrombotic therapy would include age, gender, average income, history of hypertension, National Institutes of Health Stroke Scale (NIHSS) score at admission while hospital related determinants would include percentage of neurological beds in total beds, and region of the hospital (P<0.05). Conclusions The quality of a hospital was associated with the adherence to early antithrombotic therapy. AIS patients at advanced age or with high NIHSS score at admission should be paid more attention.
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