基于层次分析法的头孢比罗、万古霉素、利奈唑胺及达托霉素多指标决策模型构建及综合评价

Construction and comprehensive evaluation of multi-index decision-making model of cephalosporin, vancomycin, linezolid and daptomycin based on AHP

关键词:  层次分析法  抗菌药物  多指标决策  综合评价  一致性分析

Key words:  analytic hierarchy process (AHP)  antibacterial drug  multiple attribute decision making  synthetic evaluation  consistency analysis

摘要:

目的 针对耐药革兰氏阳性菌所致血流感染的抗菌药物选择的复杂性，构建基于层次分析法（analytic hierarchy process，AHP）的多指标决策模型进行综合评价，为临床选择提供数据参考。方法 通过多评价指标：药效学（MIC值等）、药动学（组织穿透性、半衰期等）、安全性（ADR发生率、肝肾毒性等）、经济学（DDD值、日均治疗费用等）、可及性（供应稳定性、医保覆盖等），构建AHP模型，以Matlab R2014a软件辅助分析。结果 头孢比罗、万古霉素、利奈唑胺和达托霉素对抗菌药物优选的贡献权重分别为0.2423、0.2249、0.2074和0.3254。组合一致性指标CI* = 0.0430，组合一致性比率CR* = 0.0478 < 0.1，符合一致性的检验标准。结论 构建的层次分析法模型通过一致性检验，综合评价结果显示：头孢比罗可作为MRSA血流感染治疗的新选择，效果仅次于达托霉素，万古霉素可作为备选。该结果仅供参考。

Abstract:

OBJECTIVE To address the complexity of selecting antimicrobial agents for the treatment of bloodstream infections caused by resistant Gram-positive bacteria, a multi-criteria decision-making model based on the AHP was constructed to conduct a comprehensive evaluation, thereby providing data-driven support for clinical decision-making. METHODS An AHP model was constructed using multiple evaluation criteria: pharmacodynamics (e.g., MIC values), pharmacokinetics (e.g., tissue penetration, half-life), safety (e.g., ADR incidence, hepatic/renal toxicity), economics (e.g., DDD cost, defined daily dose cost), and accessibility (e.g., supply stability, medical insurance coverage). Analysis was performed using Matlab R2014a software. RESULTS The contribution weights of ceftobiprole, vancomycin, linezolid, and daptomycin to the optimal antimicrobial selection were 0.2423、0.2249、0.2074 and 0.3254, respectively. The composite consistency index (CI*) was 0.0430, and the composite consistency ratio (CR*) was 0.0478 (< 0.1), meeting the consistency test criterion. CONCLUSION The constructed AHP model passed the consistency test, and the comprehensive evaluation results indicate that ceftobiprole can be considered as a new treatment option for MRSA bloodstream infections, with efficacy second only to daptomycin, while vancomycin may serve as an alternative. It should be noted that these findings are for reference only.