目的 本研究通过开展抗精神病药的剂量研究,描述抗精神病药处方剂量的高低,并探索高剂量用药的影响因素。方法 利用北京大学第六医院既往电子病历记录开展回顾性纵向研究,通过真实世界研究描述患者抗精神病药用药特征,分析成年精神分裂症患者的抗精神病药累积平均日剂量,使用logistic回归对高剂量用药的影响因素进行多因素分析。结果 ①95.3%的患者使用了二代抗精神病药,97.2%的患者使用了口服剂型,71.9%的患者在随访期间曾同时使用2种以上抗精神病药,17.9%的患者在随访期间因精神疾病住院;②56.3%患者的累积平均日剂量为中等剂量,低剂量比例高于高剂量。各层患者累积平均日剂量分布与整体患者类似;③多种抗精神病药并用增加累积平均日剂量,校正OR分别为3.0(高剂量对比非高剂量)、8.2(高剂量对比低剂量)、2.3(高剂量对比中等剂量)。随访期间住院是否影响累积平均日剂量达到高剂量的多因素回归结果不一致;④结果表明多种抗精神病药并用增加累积平均日剂量,用药实践中应警惕多种抗精神病药并用产生的后果。结论 研究结果可用于探讨以累积平均日剂量评价患者用药合理性和对药物不良反应预警的可能性。
Abstract
OBJECTIVE To analyze the prescription dosage of antipsychotics, and explore the influencing factors of high-dose medication through descriptive research on the dosage of antipsychotics. METHODS A retrospective longitudinal study was carried out using electronic medical records of Peking University Sixth Hospital. The characteristics of patients′ antipsychotic medications were described through real-world studies, and the cumulative average daily dose of antipsychotics in adult patients with schizophrenia was analyzed.Logistic regression was used to analyze the influencing factors of high-dose medication. RESULTS ①The 95.3% of the patients used second-generation antipsychotics, 97.2% used oral dosage forms, 71.9% used two or more antipsychotics at the same time during the follow-up period, and 17.9% of the patients were hospitalized during the follow-up period; ②The cumulative average daily dose of 56.3% patients was medium dose, and the proportion of low dose was higher than that of high dose. The cumulative average daily dose distribution of patients in each layer is similar to the overall patient; ③The combined use of multiple antipsychotics increased the cumulative average daily dose, and the corrected OR is 3.0 (high dose vs non-high dose) and 8.2 (high dose vs low dose), 2.3 (high dose vs medium dose). During the follow-up period, whether the hospitalization affects the cumulative average daily dose to reach the high dose, the multi-factor regression RESULTS are inconsistent; ④The RESULTS indicated that the combined use of multiple antipsychotics increases the cumulative average daily dose, and the consequences of the combined use of multiple antipsychotics should be vigilant. CONCLUSION The RESULTS of the study can be used to explore the possibility of evaluating the rationality of patients′ medication and warning of adverse drug reactions based on the cumulative average daily dose.
关键词
抗精神病药 /
剂量 /
真实世界数据 /
限定日剂量
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Key words
antipsychotics /
dosage /
real-world data /
defined daily dose
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中图分类号：
R749.3
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参考文献
[1] TORNIAINEN M, MITTENDORFER-RUTZ E, TANSKANEN A, et al. Antipsychotic treatment and mortality in schizophrenia [J]. Schizophr Bull, 2015, 41(3): 656-663.
[2] RAY W A, CHUNG C P, MURRAY K T, et al. Atypical antipsychotic drugs and the risk of sudden cardiac death [J]. N Engl J Med, 2009, 360(3): 225-235.
[3] RAY W A, STEIN C M, MURRAY K T, et al. Association of antipsychotic treatment with risk of unexpected death among children and youths [J]. JAMA Psychiatry, 2019, 76(2): 162.
[4] ROH D, CHANG J G, KIM C H, et al. Antipsychotic polypharmacy and high-dose prescription in schizophrenia: A 5-year comparison [J]. Aust N Z J Psychiatry, 2014, 48(1): 52-60.
[5] ROH D, CHANG J G, YOON S, et al. Antipsychotic prescribing patterns in first-episode schizophrenia: A five-year comparison [J]. Clin Psychopharmacol Neurosci, 2015, 13(3): 275-282.
[6] QIU H, HE Y, ZHANG Y, et al. Antipsychotic polypharmacy in the treatment of schizophrenia in China and Japan [J]. Aust N Z J Psychiatry, 2018, 52(12): 1202-1212.
[7] CHEN J L, ZHANG M, LI L X, et al. Review of antipsychotic drugs utilization in two major psychiatric hospital in Guangzhou during 2010-2014 [J]. Pharm Today(今日药学), 2015, 25(5): 343-346.
[8] ZHANG X, XU L C, HUANG K. Analysis of the utilization of antipsychotic drugs in 26 hospitals from Hangzhou area during 2009-2011 [J]. J China Pharm(中国药房), 2013, 24(22): 2035-2038.
[9] ZHANG Y S, WANG J, XU N, et al. The frequency of the use of antipsychotics in a provincial mental health center from 2002 to 2011 [J]. Chin Gen Pract(中国全科医学), 2016, 19(11): 1342-1346.
[10] WHO. ATC/DDD Index 2020 [S]. 2021, Oslo, Norway: World Health Organization.
[11] WHO. International working group for drug statistics methodology, drug utilization metrics and their applications. introduction to drug utilization research [S]. 2003, Oslo, Norway: World Health Organization, 38-41.
[12] CARMONA-HUERTA J, CASTIELLO-DE O S, RAMIREZ-PALOMINO J, et al. Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification [J]. BMC Psychiatry, 2019, 19(1): 78.
[13] BERLING I, BUCKLEY N A, ISBISTER G K. The antipsychotic story: changes in prescriptions and overdose without better safety [J]. Br J Clin Pharmacol, 2016, 82(1): 249-254.
[14] CAO G Y, WANG C G, CHEN M H, et al. Rhabdomyolysis after antipsychotic use: case reports and literature review[J]. Chin Pharm J(中国药学杂志), 2019, 54(18): 1527-1533.
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脚注
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基金
北京市科委重大项目-精神分裂症首发人群急性期药物疗效预测及复发高危人群预警模型建立及验证研究资助(D171100007017002)
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