2015年—2019年中国6城市门诊肝病辅助用药的真实世界数据分析

赵紫楠; 吕俊玲; 杨蕾; 张亚同

doi:10.3969/j.issn.1001-5256.2021.11.021

2015年—2019年中国6城市门诊肝病辅助用药的真实世界数据分析

DOI: 10.3969/j.issn.1001-5256.2021.11.021

1.
北京医院药学部，国家老年医学中心，中国医学科学院老年医学研究所，药物临床风险与个体化应用评价北京市重点实验室，北京 100730
2.
北京医院临床试验研究中心，国家老年医学中心，中国医学科学院老年医学研究所，北京 100730

基金项目:

国家重点研发计划 (2020YFC2008301);

国家重点研发计划 (2020YFC2009001);

“国家重大新药创制”科技重大专项 (2017zx09101001)

详细信息

通信作者:
张亚同，zyt2002888@foxmail.com

中图分类号: R575
计量
- 文章访问数: 596
- HTML全文浏览量: 168
- PDF下载量: 118
- 被引次数: 0
出版历程
- 收稿日期: 2021-03-30
- 录用日期: 2021-04-25
- 出版日期: 2021-11-20

A real-world data analysis of the use of hepatoprotective drugs in outpatients in six cities of China from 2015 to 2019

1.
Department of Pharmacy, National Center of Gerontology, Beijing Hospital; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences; Assessment of Clinical Drugs Risk and Individual Application Key Laboratory, Beijing 100730, China
2.
Clinical Trial Center, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing 100730, China

Research funding:

China National Key R&D Program (2020YFC2008301);

China National Key R&D Program (2020YFC2009001);

"National major new drug development and development" Major Science and Technology Project (2017zx09101001)

摘要

摘要: 目的探寻近年来国内门诊肝病辅助用药使用情况，分析并提出建议。方法抽取2015年—2019年我国6座城市85家医院含有肝病辅助用药的门诊处方数据，使用真实世界数据分析的方法对肝病辅助用药处方的付费方式、开具科室、药品类别和用药情况进行分析。结果共提取处方数据1 113 575张，涉及复方甘草酸苷、多烯磷脂酰胆碱、双环醇等38种肝病辅助用药。肝病辅助用药使用以三级医院为主，开具肝病辅助用药最多的科室包括感染科、消化内科和结核科。以抗炎类肝病辅助用药处方量占比最高，具体品种以复方甘草酸苷、多烯磷脂酰胆碱和双环醇最多。253 429张处方(占处方总量的22.76%)存在多种肝病辅助用药物联合使用情况，联用数量最多达6种，其中以多烯磷脂酰胆碱联合双环醇的占比最高。结论我国门诊患者肝病辅助用药物用量较大，目前临床应用合理性较好，但仍存在合并用药多等问题有待解决。
- 肝病辅助用药 /
- 药物处方 /
- 真实世界数据
Abstract: Objective To investigate the use of hepatoprotective drugs in China in recent years, and to put forward related suggestions. Methods The outpatient prescription data of hepatoprotective drugs were collected from 85 hospitals in 6 cities of China from 2015 to 2019, and a real-world data analysis was performed to analyze the payment method, issuing department, drug category, and use of hepatoprotective drugs. Results A total of 1 113 575 prescriptions were extracted, involving 38 hepatoprotective drugs such as compound glycyrrhizin, polyene phosphatidylcholine, and bicyclol. Hepatoprotective drugs were mainly in tertiary hospitals, and the highest number of prescriptions containing hepatoprotective drugs were observed in department of infectious diseases, department of gastroenterology, and department of tuberculosis. Anti-inflammatory hepatoprotective drugs accounted for the highest proportion of all prescriptions, mainly compound glycyrrhizin, polyene phosphatidylcholine, and bicyclol. Of all prescriptions, 253 429 (22.76%) had the combination of multiple hepatoprotective drugs, with the highest number of 6 drugs, among which polyene phosphatidylcholine combined with bicyclol accounted for the highest proportion. Conclusion There are large quantities of hepatoprotective drugs used by outpatients in China. At present, the hepatoprotective drugs are clinically applied rationally, but there are still some problems to be solved, such as the combination of drugs.
- Hepatoprotective Drugs /
- Drug Prescriptions /
- Real-World Data

HTML全文

图 1 2015年—2019年我国6座城市肝病辅助用药处方开具情况

下载: 全尺寸图片幻灯片

图 2 2016年—2019年我国6座城市肝病辅助用药处方量及金额增长情况

下载: 全尺寸图片幻灯片

图 3 2015年—2019年我国6座城市肝病辅助用药处方开具科室情况

下载: 全尺寸图片幻灯片

图 4 2015年—2019年我国6座城市肝病辅助用药处方开具类别情况

下载: 全尺寸图片幻灯片

表 1 重点科室肝病辅助用药具体情况

科室	药品通用名称	分类	处方量(张)
感染科	复方甘草酸苷	抗炎类	41 881
感染科	双环醇	降酶类	33 380
感染科	甘草酸二铵	抗炎类	27 582
消化内科	多烯磷脂酰胆碱	促肝细胞再生类	40 125
消化内科	双环醇	降酶类	25 702
消化内科	甘草酸二铵	抗炎类	22 648
结核科	复方甘草酸苷	抗炎类	26 371
结核科	甘草酸二铵	抗炎类	11 526
结核科	双环醇	降酶类	8622

下载: 导出CSV

表 2 2015年—2019年我国6座城市肝病辅助用药处方开具联合用药情况

联合用药数	组合方案数	最常见联合情况(前3名)	处方量(张)
双药联用	199种	多烯磷脂酰胆碱+双环醇多烯磷脂酰胆碱+甘草酸二铵多烯磷脂酰胆碱+复方甘草酸苷	231 991
三药联用	312种	多烯磷脂酰胆碱+双环醇+水飞蓟素多烯磷脂酰胆碱+复方甘草酸苷+双环醇多烯磷脂酰胆碱+双环醇+水飞蓟宾	20 174
四药联用	79种	多烯磷脂酰胆碱+复方甘草酸苷+双环醇+水飞蓟素复方二氯醋酸二异丙胺+联苯双酯+门冬氨酸鸟氨酸+双环醇多烯磷脂酰胆碱+甘草酸二铵+双环醇+水飞蓟素	1213
五药联用	6种	多烯磷脂酰胆碱+复方甘草酸苷+甘草酸二铵+双环醇+水飞蓟素多烯磷脂酰胆碱+复方甘草酸苷+联苯双酯+门冬氨酸鸟氨酸+葡醛内酯多烯磷脂酰胆碱+复方甘草酸苷+门冬氨酸鸟氨酸+腺苷蛋氨酸+异甘草酸镁	45
六药联用	1种	多烯磷脂酰胆碱+复方甘草酸苷+甘草酸二铵+葡醛内酯+双环醇+腺苷蛋氨酸	6

下载: 导出CSV

参考文献(20)

[1]	LI GF, ZHANG ZY, YANG CM, et al. Classification and action of common hepatoprotective drugs[J]. China Prac Med, 2012, 7(26): 236-238. DOI: 10.14163/j.cnki.11-5547/r.2012.26.212. 黎规丰, 张周英, 杨成密, 等. 常见保肝药的分类及作用[J]. 中国实用医药, 2012, 7(26): 236-238. DOI: 10.14163/j.cnki.11-5547/r.2012.26.212.
[2]	ZHAO RQ, YAO L. Present situation and evaluation of hepatoprotective drugs[J]. J Infect Dis Pharm, 2000, 10(3): 16-18. DOI: 10.13493/j.issn.1672-7878.2000.03.009. 赵汝钦, 么玲. 保肝药的现状和评价[J]. 传染病药学, 2000, 10(3): 16-18. DOI: 10.13493/j.issn.1672-7878.2000.03.009.
[3]	LIU JY, ZHANG CL, LI XP, et al. Utilization analysis of hepatoprotective drugs of 34 hospitals in Wuhan area during 2012-2014[J]. Chin J Pharmacoepidemiol, 2016, 25(2): 113-118. DOI: CNKI:SUN:YWLX.0.2016-02-012. 刘金玉, 张程亮, 李喜平, 等. 2012-2014年武汉地区34家医院保肝药应用分析[J]. 药物流行病学杂志, 2016, 25(2): 113-118. DOI: CNKI:SUN:YWLX.0.2016-02-012.
[4]	National Health Commission of the People's Republic of China, Medical Administration and Medical Authorit. Notice on the management of clinical application of adjuvant drugs [EB/OL]. [2018-12-12] (2020-08-27). http://www.nhc.gov.cn/yzygj/s7659/201812/bc0259007f1a4cf38cb5d0352470e33e.shtml'2018 国家卫生健康委员会, 医政医管局. 关于做好辅助用药临床应用管理有关工作的通知[EB/OL]. [2018-12-12] (2020-08-27). http://www.nhc.gov.cn/yzygj/s7659/201812/bc0259007f1a4cf38cb5d0352470e33e.shtml'2018
[5]	Chinese Society of Infectious Diseases, Expert Consensus Committee on Liver Inflammation and Its Prevention and Treatment. Prevention and management of liver inflammation: An expert consensus in China[J]. Chin J Clin Infect Dis, 2014, 7(1): 4-12. DOI: 10.3760/cma.j.issn.1674-2397.2014.01.002. 中华医学会感染病学分会, 肝脏炎症及其防治专家共识专家委员会. 肝脏炎症及其防治专家共识[J]. 中华临床感染病杂志, 2014, 7(1): 4-12. DOI: 10.3760/cma.j.issn.1674-2397.2014.01.002.
[6]	CAO M, LI X, ZHANG B, et al. The effect of polyene phosphatidyl choline intervention on nonalcoholic steatohepatitis and related mechanism[J]. Am J Transl Res, 2016, 8(5): 2325-2330.
[7]	WEN XL, ZHANG HL. Literature anaiysis of adverse reactions caused by poiyene phosphatidyi choiine [J]. Chin J Pharmacov, 2020, 17(8): 526-530. DOI: 10.19803/j.1672-8629.2020.08.16. 文晓玲, 张海浪. 多烯磷脂酰胆碱不良反应文献分析[J]. 中国药物警戒, 2020, 17(8): 526-530. DOI: 10.19803/j.1672-8629.2020.08.16.
[8]	YANG YL, ZHANG ZQ, WEI YQ. Clinical study on silybinin combined with polyene phosphatidylcholine for nonalcoholic fatty liver disease[J]. J New Chin Med, 2020, 52(18): 81-84. DOI: 10.13457/j.cnki.jncm.2020.19.023. 杨亚莉, 张志强, 魏毅强. 水飞蓟宾联合多烯磷脂酰胆碱治疗非酒精性脂肪肝临床研究[J]. 新中医, 2020, 52(18): 81-84. DOI: 10.13457/j.cnki.jncm.2020.19.023.
[9]	CHEN JH, XU YM. Clinical effect of polyene phosphatidylcholine combined with metformin in the treatment of non-alcoholic fatty liver disease [J]. Chronic Pathematol J, 2020, 21(6): 885-886. DOI: 10.16440/j.cnki.1674-8166.2020.06.031. 陈建辉, 许亚妹. 多烯磷脂酰胆碱联合二甲双胍治疗非酒精性脂肪肝临床效果[J]. 慢性病血杂志, 2020, 21(6): 885-886. DOI: 10.16440/j.cnki.1674-8166.2020.06.031.
[10]	CHENG ZH. Clinical effect of polyene phosphatidylcholine combined with reduced glutathione in the treatment of alcoholic hepatitis [J]. Chin J Med Devi, 2020, 33(19): 115-116. DOI: 10.14163/J.CNKI.11-5547/R.2015.09.112. 程灶鸿. 多烯磷脂酰胆碱联合还原型谷胱甘肽治疗酒精性肝炎患者的临床效果[J]. 医疗装备, 2020, 33(19): 115-116. DOI: 10.14163/J.CNKI.11-5547/R.2015.09.112.
[11]	LI CY, SHI YH. Effect of polyene phosphatidylcholine on liver fibrosis and liver function of alcoholic fatty liver[J]. Hainan Med J, 2020, 31(13): 1649-1651. DOI: 10.3969/j.issn.1003-6350.2020.13.004. 李传元, 石益海. 多烯磷脂酰胆碱对酒精性脂肪肝肝纤维化及肝功能的影响[J]. 海南医学, 2020, 31(13): 1649-1651. DOI: 10.3969/j.issn.1003-6350.2020.13.004.
[12]	XU H, GAO ZW, LIU JX, et al. Effect of polyene phosphatidylcholine on liver fibrosis and liver function of alcoholic fatty liver [J]. Hainan Med J, 2018, 15(4): 164-167. DOI: 10.3969/j.issn.1003-6350.2020.13.004. 徐辉, 高志文, 刘健许, 等. 多烯磷脂酰胆碱胶囊联合还原型谷胱甘肽治疗抗结核药物致肝损伤患者的临床疗效[J]. 实用医院临床杂志, 2018, 15(4): 164-167. DOI: 10.3969/j.issn.1003-6350.2020.13.004.
[13]	SHI L. Analysis of the effects of polyene phosphatidylcholine combined with silybin on liver function and blood lipid levels in patients with chronic hepatitis B[J]. Chin J Pharm Econom, 2020, 15(5): 94-97. DOI: 10.12010/j.issn.1673-5846.2020.05.021. 时岚. 多烯磷脂酰胆碱联合水飞蓟宾对慢性乙型肝炎患者肝功能及血脂水平的影响[J]. 中国药物经济学, 2020, 15(5): 94-97. DOI: 10.12010/j.issn.1673-5846.2020.05.021.
[14]	SHANG YH. Efficacy of bicyclol combined with polyene phosphatidylcholine in the treatment of hyperthyroid liver injury [J]. Chin J Modern Drug Appl, 2020, 14(4): 9-11. DOI: 10.14164/j.cnki.cn11-5581/r.2020.04.004. 尚月华. 双环醇联合多烯磷脂酰胆碱治疗甲亢性肝损伤的疗效观察[J]. 中国现代药物应用, 2020, 14(4): 9-11. DOI: 10.14164/j.cnki.cn11-5581/r.2020.04.004.
[15]	XIE W, YU YC. Expert consensus on clinical application of bicyclol—2020 edition [J/CD]. Chin J Exp Clin Infect Dis (Electronic Edition), 2020, 14(3): 177-185. DOI: 10.3877/cma.j.issn.1674-1358.2020.03.001. 谢雯, 于乐成. 双环醇临床应用专家共识——2020版[J/CD]. 中华实验和临床感染病杂志(电子版), 2020, 14(3): 177-185. DOI: 10.3877/cma.j.issn.1674-1358.2020.03.001.
[16]	LI H, LI JR, HUANG MH, et al. Bicyclol attenuates liver inflammation induced by infection of hepatitis C virus via repressing ROS-mediated activation of MAPK/NF-κB signaling pathway[J]. Front Pharmacol, 2018, 9: 1438. DOI: 10.3389/fphar.2018.01438.
[17]	LIU JL, BAI YM, TIAN GS. Progress in the application of compound glycyrrhizin in liver diseases [J]. Chin Pharm, 2006, 23: 1828-1830. DOI: 10.3969/j.issn.1001-0408.2006.23.031. 刘君澜, 白永敏, 田庚善. 复方甘草酸苷在肝病领域的应用进展[J]. 中国药房, 2006, 23: 1828-1830. DOI: 10.3969/j.issn.1001-0408.2006.23.031.
[18]	DU DF, WANG RZ. Efficacy of compound glycyrrhizin with narrow-band ultraviolet radiation in the treatment of psoriasis vulgaris and its effect on cytokines and proliferation genes[J]. J Clin Exp Med, 2020, 19(3): 307-310. DOI: 10.3969/j.issn.1671-4695.2020.03.024. 杜聃峰, 汪睿志. 复方甘草酸苷联合NB-UVB治疗寻常性银屑病的疗效及对细胞因子和增殖基因的影响[J]. 临床和实验医学杂志, 2020, 19(3): 307-310. DOI: 10.3969/j.issn.1671-4695.2020.03.024.
[19]	WU P. Analysis on the use of hepatoprotective drugs in inpatients in our hospital[J]. Clin Ration Drug Use, 2020, 13(2A): 109-110. DOI: 10.15887/j.cnki.13-1389/r.2020.04.063. 吴璠. 我院住院患者保肝药使用情况分析[J]. 临床合理用药, 2020, 13(2A): 109-110. DOI: 10.15887/j.cnki.13-1389/r.2020.04.063.
[20]	National Healthcare Security Administration, Ministry of Human Resources and Social Security of the People's Republic of China. "National Basic Medical Insurance, Industrial Injury Insurance and Maternity Insurance Drug Catalogue (2020)" [EB/OL]. [2020-12-25] (2021-03-30). http://www.nhsa.gov.cn/art/2019/8/20/art_37_1666.html 国家医保局, 人力资源社会保障部. 《国家基本医疗保险、工伤保险和生育保险药品目录(2020年)》的通知[EB/OL]. [2020-12-25] (2021-03-30). http://www.nhsa.gov.cn/art/2019/8/20/art_37_1666.html