杭州地区调脂药物的应用调研

Utilization Study of Lipid-lowering Drugs in Hangzhou District

关键词:  调脂药  他汀类  药物利用  相互作用  合理用药

Key words:  lipid-lowering drugs  statins  drug utilization  drug interaction  rational drug use

摘要:

目的 了解杭州地区调脂药物的临床应用情况，发现潜在的用药风险。方法 对中国药学会《医院处方分析》项目杭州地区的数据进行数据挖掘，使用Microsoft Visual FoxPro 9.0 SP2软件进行数据处理。结果 应用调脂药的男性患者数是女性患者数的1.40倍。40岁以下接受调脂药治疗的患者达3.81%，60岁以上老年患者占70.18%。在相互作用方面，氟伐他汀与5种CYP2C9抑制剂和9种CYP2C9底物合用的处方总量占氟伐他汀处方总量的11.7%。辛伐他汀、阿托伐他汀和洛伐他汀与CYP3A4抑制剂(n=10)和CYP3A4底物(n=23)合用的处方总量占这3种他汀处方总量的51.7%，有潜在的相互作用的风险。调脂药物在心内科应用最广。他汀类药物在神经内科和内分泌科也有较多应用。在各类调脂药物中，他汀类药物占80.0%，苯氧酸类13.4%，烟酸类4.8%，抗氧化剂0.35%，多烯脂肪酸类0.30%。他汀类中阿托伐他汀钙、辛伐他汀、普伐他汀和氟伐他汀的处方量份额分别为50.6%、27.3%、10.9%和11.1%。结论 临床已开始重视强化降脂治疗，他汀类的非降脂作用使得该类药物临床应用越来越广。老年患者往往患多种疾病，接受多重药物治疗，因此要充分重视调脂药与其他药理和治疗类别药物的相互作用。注意潜在相互作用带来的安全性改变，有必要做好用药教育和疗程中的药物治疗监测。

Abstract:

OBJECTIVE To know the utilizing status of lipid-lowering drugs and anticipate potential medication risks. METHODS Data mining was performed on corresponding information on Hangzhou District from Project on Prescription Analysis organized by Chinese Pharmaceutical Society. Microsoft Visual FoxPro 9.0 SP2 was used to data process. RESULTS Number of male patients was 1.40 times that of female patients. Ratio of patients below 40 years old was 3.81% and ratio of patients older than 60 years was 70.18%. With respect to drug interaction, number of recipes containing fluvastatin and CYP2C9 inhibitors (n=5) or CYP2C9 substrates (n=9) contribute to 11.7% of total recipes containing fluvastatin. Number of recipes containing three statins (lovastatin, simvastatin and atorvastatin) and CYP3A4 inhibitors (n=10) or CYP3A4 substrates (n=23) contribute to 51.7% of total recipes containing these three statins. These concurrent therapies exist potential risks. Lipid-lowering drugs were most prescribed in department of cardiology. Statins were also used usually in neurological department and endocrine department. The relative percentage of recipe numbers of five kinds of lipid-lowering drugs were as follows: statins(80.0%), phenoxyacetic acid derivatives(13.4%), nicotinic acids (4.8%), antioxidants(0.35%) and polyunsaturated fatty acid( 0.30%). The relative percentage of recipe numbers of four statins were as follows: atorvastatin(50.6%), simvastatin(27.3%), pravastatin(10.9%) and fluvastatin(11.1%). CONCLUSION Intensive lipid lowing therapy was performed and beyond lipid lowering effects of statins made them wide use in clinical practice. Geriatric patients usually suffered from multiple diseases and received multiple medications and thus more attention should be paid to prevent potential drug interactions between lipid-lowing drugs and other drugs. Patient education and pharmacotherapy monitoring are necessary.