9种慢性病的临床指南中的潜在药物相互作用研究
|
摘要
目的:提高医务人员对潜在药物相互作用(以下简称"药物相互作用")的认识,减少因药物相互作用导致的药品不良事件,为慢性病临床指南制定提供参考。方法:依据《中国居民营养与慢性病调查报告》与相关文献,选取9种常见慢性病(高血压、2型糖尿病、血脂异常、抑郁、原发性肺癌、类风湿性关节炎、缺血性脑卒中、慢性心力衰竭和慢性阻塞性肺疾病)对应的由中华医学会或国家卫生和计划生育委员会牵头制订的最新的临床指南,评估指南中药物相互作用方面的完善程度。检索Micromedex、Stock-ley’s Drug Interactions、Medscape、Adverse Drug Interactions:A Handbook for prescribers和药品说明书等数据库或资料,以与其他慢性病共存可能性最大及发病率最高的高血压、2型糖尿病、血脂异常疾病的临床指南为中心,统计这3种慢性病的指南推荐药物与除自身外的8种慢性病指南推荐药物之间相互作用的数量(包括轻/中度及严重药物相互作用),同时统计具有严重相互作用数量较多的药物。结果:尚无指南提及共患病推荐药物之间相互作用。高血压、2型糖尿病、血脂异常临床推荐药物与除自身外的8种疾病临床指南推荐治疗药物之间具有轻/中度药物相互作用的数量分别为759、681、68个,具有严重药物相互作用的数量分别为262、17、37个。存在严重相互作用数量较多的药物为地高辛(24个)、阿司匹林(22个)、利尿剂(12种药物,14～17个)等。结论:当患者同时患有多种慢性病时,临床药师用药需关注药物相互作用的问题,本研究选取的慢性病临床指南仍待完善药物相互作用的内容。
OBJECTIVE:To reduce ADEs due to potential drug interaction(short for drug interaction)by improving medical staffs' recognition,and to provide reference for making clinical guidelines for chronic disease. METHODS: According to the Survey Reprots on Chinese Resident's Nutrition and Chronic Disease and related literatures,nine common chronic diseases(hypertension,type 2 diabetes mellitus,dyslipidemia,depression,primary lung cancer,rheumatoid arthritis,ischemic stroke,chronic heart failure and chronic obstructive pulmonary disease) and latest corresponding clinical guidelines,developed by the Chinese Medical Association or National Health and Family Planning Commission were selected to evaluate the improvement of drug interaction in the guidelines. Retrieving Micromedex,Stockley's Drug Interactions,Medscape,Adverse drug interactions:A Handbook for prescribers and drug instructions, centered on the clinical guidelines for hypertension, type 2 diabetes and dyslipidemia,which were most likely to coexist with other chronic diseases and had the highest incidence,the number of drug interactions(mild/medium and severe drug interaction) of drugs recommended by 3 chronic disease guidelines and 8 other guidelines were counted,and drugs with a large number of severe drug interactions were also counted. RESULTS:There was no guideline to discussing the interaction between recommended drugs for comorbidity. The number of mild/mediuem drug reactions recommended by clinical guidelines for hypertension,type 2 diabetes,dyslipidemia and other 8 disease were 759,681 and 68,respectively;those of severe drug interaction were 262,17 and 37,respectively. The drugs with a high number of severe drug interactions were digoxin(24),aspirin(22),diuretics(12 kinds of drugs,14-17). CONCLUSIONS:When patients suffer from multiple chronic diseases,clinical pharmacists should pay attention to drug interactions. Selected clinical guidelines for chronic diseases still need to be completed the content of drug interactions.
OBJECTIVE:To reduce ADEs due to potential drug interaction(short for drug interaction)by improving medical staffs' recognition,and to provide reference for making clinical guidelines for chronic disease. METHODS: According to the Survey Reprots on Chinese Resident's Nutrition and Chronic Disease and related literatures,nine common chronic diseases(hypertension,type 2 diabetes mellitus,dyslipidemia,depression,primary lung cancer,rheumatoid arthritis,ischemic stroke,chronic heart failure and chronic obstructive pulmonary disease) and latest corresponding clinical guidelines,developed by the Chinese Medical Association or National Health and Family Planning Commission were selected to evaluate the improvement of drug interaction in the guidelines. Retrieving Micromedex,Stockley's Drug Interactions,Medscape,Adverse drug interactions:A Handbook for prescribers and drug instructions, centered on the clinical guidelines for hypertension, type 2 diabetes and dyslipidemia,which were most likely to coexist with other chronic diseases and had the highest incidence,the number of drug interactions(mild/medium and severe drug interaction) of drugs recommended by 3 chronic disease guidelines and 8 other guidelines were counted,and drugs with a large number of severe drug interactions were also counted. RESULTS:There was no guideline to discussing the interaction between recommended drugs for comorbidity. The number of mild/mediuem drug reactions recommended by clinical guidelines for hypertension,type 2 diabetes,dyslipidemia and other 8 disease were 759,681 and 68,respectively;those of severe drug interaction were 262,17 and 37,respectively. The drugs with a high number of severe drug interactions were digoxin(24),aspirin(22),diuretics(12 kinds of drugs,14-17). CONCLUSIONS:When patients suffer from multiple chronic diseases,clinical pharmacists should pay attention to drug interactions. Selected clinical guidelines for chronic diseases still need to be completed the content of drug interactions.
引文
[1]国家卫生和计划生育委员会统计信息中心.2013第五次国家卫生服务调查分析报告[R].2016-10-26.
[2]PIRMOHAMED M,JAMES S,MEAKIN S,et al.Adverse drug reactions as cause of admission to hospital:prospective analysis of 18 820 patients[J].BMJ,2004,329(7456):15-19.
[3]SHAPIRO LE,SHEAR NH.Drug-drug interactions:how scared should we be?[J].CMAJ,1999,161(10):1266-1267.
[4]WIGGINS BS,SASEEN JJ,PAGE RL,et al.Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease:a scientific statement from the American heart association[J].Circulation,2016,134(21):e468-e495.
[5]DUMBRECK S,FLYNN A,NAIRN M,et al.Drug-disease and drug-drug interactions:systematic examination of recommendations in 12 UK national clinical guidelines[J].BMJ,2015,DOI:10.1136/bmj.h949.
[6]HUGHES LD,MCMURDO ME,GUTHRIE B.Guidelines for people not for diseases:the challenges of applying UK clinical guidelines to people with multimorbidity[J].Age and Ageing,2013,42(1):62-69.
[7]肖桂荣,张莹,马晴,等.国内外结核病诊疗指南中关于抗结核药物相互作用管理的分析[J].华西医学,2015,30(5):954-958.
[8]马利娟,赵琦,冯蕾心,等.医院合理用药理念下药物相互作用认知度调查与分析[J].光明中医,2017,32(22):3205-3208.
[9]国家卫生和计划生育委员会疾病预防控制局.中国居民营养与慢性病状况报告(2015)[M].北京:人民卫生出版社,2016:1-23.
[10]钱军程,陈育德,徐玲,等.中国老年人口主要慢性病患病率变化与突发增长的分析[J].中国卫生信息管理杂志,2011,8(3):70-74.
[11]申珂,郭娜娜,邓健,等.中国近40年慢性病疾病谱变化情况[J].山西医药杂志,2017,46(8):903-905.
[12]崔娟,毛凡,王志会.中国老年居民多种慢性病共存状况分析[J].中国公共卫生,2016,32(1):66-69.
[13]王一然,王奇金.慢性病防治的重点和难点:《中国防治慢性病中长期规划(2017-2025年)》解读[J].第二军医大学学报,2017,38(7):828-831.
[14]IBM Watson Health.Drug interaction[EB/OL].[2018-08-10].http://www.micromedexsolutions.com/micromedex2/librarian/.
[15]KAREN B.Stockley’s Drug Interactions[M].9th edition.London:Pharmaceutical Press,2010:179-181.
[16]Medscape.Drug interaction checker[EB/OL].[2018-08-10].https://reference.medscape.com/drug-interactionchecker.
[17]KARALLIEDDE L,CLARKE SF,COLLIGNON U,et al.Adverse Drug Interactions:A Handbook for prescribers[M].London:Hodder Arnold,2010:1-1089.
[18]TSO GJ,TU SW,MUSEN MA,et al.High-risk drug-drug interactions between clinical practice guidelines for management of chronic conditions[J].AMIA Jt Summits Transl Sci Proc,2017,2017:531-539.
[19]蒋立新,刘立生,高润霖,等.国家基层高血压防治管理指南[J].中国循环杂志,2017,32(11):1041-1048.
[20]贾伟平,陆菊明,纪立农,等.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志,2018,38(4):292-344.
[21]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.
[22]李凌江,马辛.中国抑郁障碍防治指南[M].2版.北京:中华医学电子音像出版社,2015:1-200.
[23]吴一龙,程颖,周清,等.中国临床肿瘤学会(CSCO)原发性肺癌诊疗指南[M].北京:人民卫生出版社,2017:1-113.
[24]中华医学会风湿病学分会.中国类风湿关节炎诊疗指南[J].中华内科杂志,2018,57(4):242-251.
[25]王拥军,刘鸣,蒲传强,等.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南(2014)[J].中华神经科杂志,2015,48(4):258-273.
[26]黄峻,杨杰孚,张健,等.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):3-10.
[27]姚婉贞.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[28]孙宁玲,霍勇.高血压合理用药指南[J].2版.中国医学前沿杂志(电子版),2017,9(7):28-126.
[29]中华医学会风湿病学分会,类风湿关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(4):265-270.
[30]杨杰孚,张健,霍勇,等.心力衰竭合理用药指南[J].中国医学前沿杂志(电子版),2016,8(9):19-66.
[31]WYNN GH,OESTERHELD JR,COZZA KL,et al.Clinical manual of drug interaction principles for medical practice[M].Arlington:American Psychiatric Publishing,2009:1-594.
[32]张新茹,付秀娟,朱大胜.1例急性冠脉综合征老年患者的药学监护[J].中国药房,2011,22(42):4024-4025.
[33]BEIJNEN JH,SCHELLENS JH.Drug interaction in oncology[J].Lancet Oncol,2004,5(8):489-496.
[34]MARENGONI A,ONDER G.Guidelines,polypharmacy,and drug-drug interactions in patients with multimorbidity[J].BMJ,2015.DOI:10.1136/bmj.h1059.
[35]ROBLEK T,TROBEC K,MRHAR A,et al.Potential drug-drug interactions in hospitalized patients with chronic heart failure and chronic obstructive pulmonary disease[J].Arch Med Sci,2014,10(5):920-932.
[2]PIRMOHAMED M,JAMES S,MEAKIN S,et al.Adverse drug reactions as cause of admission to hospital:prospective analysis of 18 820 patients[J].BMJ,2004,329(7456):15-19.
[3]SHAPIRO LE,SHEAR NH.Drug-drug interactions:how scared should we be?[J].CMAJ,1999,161(10):1266-1267.
[4]WIGGINS BS,SASEEN JJ,PAGE RL,et al.Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease:a scientific statement from the American heart association[J].Circulation,2016,134(21):e468-e495.
[5]DUMBRECK S,FLYNN A,NAIRN M,et al.Drug-disease and drug-drug interactions:systematic examination of recommendations in 12 UK national clinical guidelines[J].BMJ,2015,DOI:10.1136/bmj.h949.
[6]HUGHES LD,MCMURDO ME,GUTHRIE B.Guidelines for people not for diseases:the challenges of applying UK clinical guidelines to people with multimorbidity[J].Age and Ageing,2013,42(1):62-69.
[7]肖桂荣,张莹,马晴,等.国内外结核病诊疗指南中关于抗结核药物相互作用管理的分析[J].华西医学,2015,30(5):954-958.
[8]马利娟,赵琦,冯蕾心,等.医院合理用药理念下药物相互作用认知度调查与分析[J].光明中医,2017,32(22):3205-3208.
[9]国家卫生和计划生育委员会疾病预防控制局.中国居民营养与慢性病状况报告(2015)[M].北京:人民卫生出版社,2016:1-23.
[10]钱军程,陈育德,徐玲,等.中国老年人口主要慢性病患病率变化与突发增长的分析[J].中国卫生信息管理杂志,2011,8(3):70-74.
[11]申珂,郭娜娜,邓健,等.中国近40年慢性病疾病谱变化情况[J].山西医药杂志,2017,46(8):903-905.
[12]崔娟,毛凡,王志会.中国老年居民多种慢性病共存状况分析[J].中国公共卫生,2016,32(1):66-69.
[13]王一然,王奇金.慢性病防治的重点和难点:《中国防治慢性病中长期规划(2017-2025年)》解读[J].第二军医大学学报,2017,38(7):828-831.
[14]IBM Watson Health.Drug interaction[EB/OL].[2018-08-10].http://www.micromedexsolutions.com/micromedex2/librarian/.
[15]KAREN B.Stockley’s Drug Interactions[M].9th edition.London:Pharmaceutical Press,2010:179-181.
[16]Medscape.Drug interaction checker[EB/OL].[2018-08-10].https://reference.medscape.com/drug-interactionchecker.
[17]KARALLIEDDE L,CLARKE SF,COLLIGNON U,et al.Adverse Drug Interactions:A Handbook for prescribers[M].London:Hodder Arnold,2010:1-1089.
[18]TSO GJ,TU SW,MUSEN MA,et al.High-risk drug-drug interactions between clinical practice guidelines for management of chronic conditions[J].AMIA Jt Summits Transl Sci Proc,2017,2017:531-539.
[19]蒋立新,刘立生,高润霖,等.国家基层高血压防治管理指南[J].中国循环杂志,2017,32(11):1041-1048.
[20]贾伟平,陆菊明,纪立农,等.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志,2018,38(4):292-344.
[21]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.
[22]李凌江,马辛.中国抑郁障碍防治指南[M].2版.北京:中华医学电子音像出版社,2015:1-200.
[23]吴一龙,程颖,周清,等.中国临床肿瘤学会(CSCO)原发性肺癌诊疗指南[M].北京:人民卫生出版社,2017:1-113.
[24]中华医学会风湿病学分会.中国类风湿关节炎诊疗指南[J].中华内科杂志,2018,57(4):242-251.
[25]王拥军,刘鸣,蒲传强,等.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南(2014)[J].中华神经科杂志,2015,48(4):258-273.
[26]黄峻,杨杰孚,张健,等.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):3-10.
[27]姚婉贞.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[28]孙宁玲,霍勇.高血压合理用药指南[J].2版.中国医学前沿杂志(电子版),2017,9(7):28-126.
[29]中华医学会风湿病学分会,类风湿关节炎诊断及治疗指南[J].中华风湿病学杂志,2010,14(4):265-270.
[30]杨杰孚,张健,霍勇,等.心力衰竭合理用药指南[J].中国医学前沿杂志(电子版),2016,8(9):19-66.
[31]WYNN GH,OESTERHELD JR,COZZA KL,et al.Clinical manual of drug interaction principles for medical practice[M].Arlington:American Psychiatric Publishing,2009:1-594.
[32]张新茹,付秀娟,朱大胜.1例急性冠脉综合征老年患者的药学监护[J].中国药房,2011,22(42):4024-4025.
[33]BEIJNEN JH,SCHELLENS JH.Drug interaction in oncology[J].Lancet Oncol,2004,5(8):489-496.
[34]MARENGONI A,ONDER G.Guidelines,polypharmacy,and drug-drug interactions in patients with multimorbidity[J].BMJ,2015.DOI:10.1136/bmj.h1059.
[35]ROBLEK T,TROBEC K,MRHAR A,et al.Potential drug-drug interactions in hospitalized patients with chronic heart failure and chronic obstructive pulmonary disease[J].Arch Med Sci,2014,10(5):920-932.