Objective: To study the changing trends of cardiac biomarker test for in-hospital patients with acute myocardial infarction (AMI) in eastern rural hospitals of China during 2001-2011. Methods: A 2-stage random sampling design was performed to select the representative in-hospital AMI patients from 32 eastern rural hospitals in 13 provinces of China at 2001, 2006 and 2011. Central data abstraction was conducted in relevant medical records, troponin and CK-MB testing situation in AMI patients was studied and the changing trends were compared among different years. Results: A total of 2853 medical records were enrolled including 5 tertiary hospitals and 27 secondary hospitals. The hospital ratios for conducting troponin or CK-MB test in 2001, 2006 and 2011 were 64.0%, 97.4% and 100% respectively; the hospital ratios for conducting troponin test were 29.3%, 70.5% and 82.0% respectively,P=0.0001. The examination rate of troponin had significant differences among the hospitals with such ability; in 2011, there were 1/4 hospitals with more than 90% AMI patients received troponin test, another 1/4 hospitals with less than 50% AMI patients received troponin test. Conclusion: Cardiac biomarker test had been commonly available during 2001-2011 in eastern rural hospitals of China, while it wasn't extensively used for AMI diagnosis even in the hospitals with such ability. It is necessary to further elevate the application rate of troponin test for improving the accuracy and sensitivity in AMI diagnosis.%目的:研究2001~2011年间我国东部农村地区医院急性心肌梗死(AMI)住院患者中心肌标志物检测的使用情况,及其十年变化趋势.方法:研究采用两阶段随机抽样我国东部13省32家医院的农村地区医院在2001年、2006年和2011年因AMI住院的代表性样本,并集中进行病历信息提取,描述医院中具备肌钙蛋白和肌酸激酶同工酶(CK-MB)检测能力的比例,以及在AMI患者中的检测率,比较不同年份间的变化趋势.结果:将来自东部农村的32家医院共2853份AMI病历纳入研究,其中三级医院5家,二级医院27家.2001年、2006年和2011年开展肌钙蛋白或CK-MB检测的医院比例分别为64.0%、97.4%、100%.其中开展肌钙蛋白检测的医院比例分别为29.3%、70.5%、82.0%,差异有统计学意义(P=0.0001).在能够开展肌钙蛋白检测的医院中,AMI患者的检测率分布差异显著,仅2011年,有四分之一的医院AMI患者检测肌钙蛋白比例超过90%,另外仍有四分之一的医院AMI患者这项检测比例不足50%.结论:2001~2011年的十年间,东部农村地区心肌标志物的检测已逐渐普及,但即使在有检测能力的医院中,尚未广泛应用于AMI的诊断.因此有必要进一步推广规范化的诊疗方案,特别是提高肌钙蛋白检测的应用率,改善AMI患者识别诊断的准确性和敏感性.
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