我国心力衰竭住院诊疗中B型利钠肽检测在医院水平的应用分析研究

doi:10.12114/j.issn.1007-9572.2019.00.748

摘要/Abstract

摘要： 背景　心力衰竭，简称心衰，给我国带来了沉重的社会和经济负担。B型利钠肽作为心衰的重要生物标志物，被国内外指南一致作为Ⅰ类推荐。然而，我国B型利钠肽检测在心衰临床诊疗中的应用情况未见报道。目的　研究分析2015年我国心衰住院诊疗中在医院水平应用B型利钠肽检测的可及性和检测率。方法　2015年“重大慢病国家注册登记研究—心力衰竭回顾性病历登记研究”（简称China PEACE心衰回顾性病历登记研究）采用分层两阶段随机抽样方法：第一阶段，将全国按经济区域划分为5层，采用简单随机抽样方法确定研究的协作医院；第二阶段，采用系统随机抽样方法，从每家协作医院抽取2015年出院诊断为心衰的住院患者病历。收集协作医院的基本信息，提取心衰患者住院病历信息，分析医院水平B型利钠肽检测的可及性和检测率，规定B型利钠肽检测率≥60%为B型利钠肽医院应用及格。结果　最终纳入188家医院共计15 163份心衰病历。2015年B型利钠肽检测的整体可及性为85.1%（160/188），各经济地域医院的B型利钠肽检测的整体可及性分布比较，差异有统计学意义（χ2=34.3，P<0.01）。多因素Logistic回归分析结果显示，有独立心内科〔OR=6.40，95%CI（1.78，23.05）〕、医院床位数>300张〔OR=4.45，95%CI（1.24，15.95）〕是医院水平B型利钠肽检测可及性的影响因素（P<0.05），同时B型利钠肽在西部农村地区的检测可及性低于东部城市地区〔OR=0.37，95%CI（0.14，0.96），P<0.05〕。159家研究的可及医院中B型利钠肽的整体检测率为63.5%（40.0%，82.3%）。各经济地域医院的B型利钠肽检测率比较，差异有统计学意义（H=13.19，P=0.01）。多因素Logistic回归分析结果显示，有独立心内科〔OR=4.91，95%CI（1.53，15.77）〕是B型利钠肽医院应用及格的影响因素（P<0.05）。结论　2015年B型利钠肽检测在全国医院水平已基本普及，但就有检测能力的医院而言，在心衰住院患者临床诊疗的检测率有待提高。因此，需要继续推广诊疗指南在临床实践中的应用，特别重视对西部农村地区的资源投入。

关键词: 心力衰竭；利钠肽, 脑；N末端脑钠肽；可及性；检测率

Abstract: Background　Heart failure，HF for short，has brought heavy social and economic burdens to our country.As an important biomarker of HF，B-type natriuretic peptide has been consistently recommended as class Ⅰ by guidelines in and abroad.However，the application of B-type natriuretic peptide detection in clinical diagnosis and treatment of HF has not been reported in China.Objective　To study the distribution of the capacity and detection rate of B-type natriuretic peptide in hospital level among inpatients with HF in China during 2015.Methods　Two-stage random sampling was used in China PEACE Retrospective Heart Failure Study：in the first stage，the study identified hospitals in five strata by region and location and extracted sample hospitals using simple random sampling；the second stage，the study obtained the database of inpatients with HF from each sample hospital during 2015，and identified cases using a systematic random sampling.The information of hospitals and hospitalized medical record was collected to analyze the distribution of the capacity and detection rate of the B-type natriuretic peptide in hospital level.The hospital with detection rate of B-type natriuretic peptide ≥60% was qualified for B-type natriuretic peptide application.Results　A total of 15 163 HF medical records from 188 hospitals were included in the study.The overall capacity of B-type natriuretic peptide detection in 2015 was 85.1%（160/188），and the difference in distribution among the strata was statistically significant（χ2=34.3，P<0.01）.Multivariate Logistic regression analysis showed that hospitals with independent cardiology department 〔OR=6.40，95%CI（1.78，23.05）〕 or >300 sheets〔OR=4.45，95%CI（1.24，15.95）〕 were more likely to be capable of B-type natriuretic peptide detection（P<0.05），and the capacity of B-type natriuretic peptide detection in western rural areas was lower than that in eastern urban areas〔OR=0.37，95%CI（0.14，0.96），P<0.05〕.The overall detection rate was 63.5%（40.0%，82.3%） from the 159 research hospitals with capacity，and the difference in distribution among the strata was statistically significant（H=13.19，P=0.01）.Multivariate Logistic regression analysis showed that hospitals with independent cardiology department were more likely to pass B-type natriuretic peptide application〔OR=4.91，95%CI（1.53，15.77），P<0.05〕.Conclusion　In 2015，the detection of B-type natriuretic peptide has been basically popularized in hospitals nationwide，but the detection rate among inpatients with HF needs to be improved.Therefore，it is necessary to promote the application of guidelines in clinical practice and resource input in western-rural region especially.

Key words: Heart failure；Natriuretic peptide, brain；NT-proBNP；Capacity；Detection rate

柴琳,白雪珂,苏萌,等. 我国心力衰竭住院诊疗中B型利钠肽检测在医院水平的应用分析研究[J]. 中国全科医学, 2020, 23(5): 553-558. DOI: 10.12114/j.issn.1007-9572.2019.00.748.
CHAI Lin,BAI Xueke,SU Meng, et al. The Application of B-type Natriuretic Peptide Detection in Hospital Level among Inpatients with Heart Failure in China　[J]. Chinese General Practice, 2020, 23(5): 553-558. DOI: 10.12114/j.issn.1007-9572.2019.00.748.

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