2001年至2011年中国急性心肌梗死患者心脏生物标志物检测趋势：中国PEACE-急性心肌梗死回顾性研究
Trends in cardiac biomarker testing in China for patients with acute myocardial infarction, 2001 to 2011: China PEACE-retrospective AMI study.
作者信息
Zhan Lijuan, Masoudi Frederick A, Li Xi, Hu Shuang, Venkatesh Arjun K, Spertus John A, Lin Zhenqiu, Desai Nihar R, Li Jing, Krumholz Harlan M, Jiang Lixin
机构信息
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America.
出版信息
PLoS One. 2015 Apr 20;10(3):e0122237. doi: 10.1371/journal.pone.0122237. eCollection 2015.
OBJECTIVES
To describe trends in the availability of biomarker testing in Chinese hospitals and how practice complies with established standards for the diagnosis of acute myocardial infarction (AMI).
BACKGROUND
Cardiac biomarker testing is standard in high-income countries, but little is known about the availability and use of cardiac biomarker testing in low- and middle-income countries (LMICs) such as China.
METHODS
Based on a nationally representative sample of Chinese hospitals in 2001, 2006 and 2011, we describe the temporal trends and regional differences in the hospital capability and rates of use of cardiac biomarker testing, as well as the variation in use across hospitals with testing capability, for patients labeled with the diagnosis of AMI.
RESULTS
We sampled 175 hospitals (162 participated in the study) and 18,631 AMI admissions. 14,370 patients were included in analysis of biomarker use. The proportion of hospitals with biomarker testing capability was 57.4% in 2001 (25.0% troponin and 32.4% creatine kinase MB fraction (CK-MB) only) and 96.3% (81.4% troponin and 14.9% CK-MB only) in 2011. The proportion of hospitals with troponin testing capability in 2011 was significantly higher in urban compared with rural hospitals (96.8% vs. 71.4%, p< 0.001). In 2011, only 55.9% of hospitals with troponin testing capability (71 out of 127 hospitals) used the assay for more than 80% of their patients with AMI. Among hospitals with either biomarker testing capability, there was marked variation in use in both rural (from 7.1% to 100.0% of patients) and urban hospitals (from 57.9% to 100.0% of patients). In 2011, 36.1% of the patients with AMI did not have troponin tested and 4.9% did not have either biomarker measured.
CONCLUSIONS
The recommended biomarker tests for AMI diagnosis are not universally available and the testing is not consistently applied when it is available in China.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01624883.
目的
描述中国医院生物标志物检测的可及性趋势，以及实际操作如何符合急性心肌梗死（AMI）诊断的既定标准。
背景
心脏生物标志物检测在高收入国家是标准操作，但对于像中国这样的低收入和中等收入国家（LMICs）心脏生物标志物检测的可及性和使用情况知之甚少。
方法
基于2001年、2006年和2011年全国代表性的中国医院样本，我们描述了心脏生物标志物检测的医院能力、使用比例的时间趋势和地区差异，以及有检测能力的医院中对诊断为AMI患者检测使用情况的差异。
结果
我们抽样了175家医院（162家参与研究）和18631例AMI住院患者。14370例患者纳入生物标志物使用情况分析。2001年有生物标志物检测能力的医院比例为57.4%（仅肌钙蛋白检测能力为25.0%，仅肌酸激酶同工酶MB（CK-MB）检测能力为32.4%），2011年为96.3%（仅肌钙蛋白检测能力为81.4%，仅CK-MB检测能力为14.9%）。2011年有肌钙蛋白检测能力的医院比例城市明显高于农村医院（96.8%对71.4%，p<0.001）。2011年，有肌钙蛋白检测能力的医院中只有55.9%（127家医院中的71家）对超过80%的AMI患者进行了该检测。在有生物标志物检测能力的医院中，农村（患者比例从7.1%到100.0%）和城市医院（患者比例从57.9%到100.0%）的使用情况都有显著差异。2011年，36.1%的AMI患者未检测肌钙蛋白，4.9%的患者两种生物标志物都未检测。
结论
用于AMI诊断的推荐生物标志物检测并非普遍可及，在中国即使可及也未得到一致应用。
试验注册
ClinicalTrials.gov NCT01624883
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