J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？

2022-06-10 吴星环球医学

2018年5月，美国学者在《J Am Heart Assoc》发表一项研究，考察血管紧张素转换酶抑制剂和血管紧张素受体阻断剂治疗老年缺血性卒中，使用率是否正确。

2018年5月，美国学者在《J Am Heart Assoc》发表一项研究，考察血管紧张素转换酶抑制剂和血管紧张素受体阻断剂治疗老年缺血性卒中，使用率是否正确。

背景：在新发缺血性卒中的老年（＞65岁）患者中，评估与肾素-血管紧张素系统拮抗剂、血管紧张素转换酶抑制剂和血管紧张素受体阻断剂（ACEI/ARBs）用于二级预防的较高使用率相关的影响，并根据慢性肾病（CKD）进行分层。

方法和结果：使用工具变量（IV）估计量，通过CKD状态评估ACEI/ARBs对生存率和肾脏风险的影响。工具基于ACEI/ARB使用的地区变异性。病历中摘取的数据用于评估工具估计量背后潜在的假设。CKD和非CKD患者中，卒中后ACEI/ARBs的使用率分别为45.9%和45.2%。不同实践模式下各地区ACEI/ARB使用率差异在CKD和非CKD患者中几乎相同。非CKD患者较高的ACEI/ARB使用率与较高的2年生存率相关，而CKD患者较高的ACEI/ARB使用率与较低的2年生存率相关。虽然CKD患者生存率的阴性估计值与零相比不具有统计学差异，但是显着低于非CKD患者的估计值。病历摘取数据的混杂因素与使用的工具变量不相关。

结论：对于合并和不合并CKD的老年缺血性卒中患者，较高的ACEI/ARB使用率具有不同的生存意义。由于较高的使用率与较高的2年生存率相关，因此ACEI/ARB在不合并CKD的缺血性卒中患者中使用不足。研究结论不能推广到合并CKD的缺血性卒中患者，这是由于较高的ACEI/ARB使用率与较低的2年生存率相关，而CKD患者的2年生存率比非CKD患者统计学显着性低。

原始出处：

Brooks JM， et al. Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients： Are the Rates Right？ J Am Heart Assoc. 2018 May 30；7(11). pii： e009137. doi： 10.1161/JAHA.118.009137.

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2018-09-29 guihongzh

#缺血性#

58 0
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2018-11-30 shanyongle

#ACE#

53 0
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2019-02-14 12498da4m32(暂无昵称)

#缺血性卒#

0 0
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2018-08-18 owlhealth

不错耶，学习了

66 0
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2018-08-11 zhaojie88

#ART#

47 0
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2018-08-11 slcumt

#HEART#

42 0
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2018-08-11 ms3830150583600765

#使用率#

43 0
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2018-08-10 健健

卒中虽然是临床上常见病，溶栓，取栓等血管内治疗也很成熟，但是仍然有很多未知问题有待认知！

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