基于定量药理的华法林个体化给药  

Individualized Medication of Warfarin by Quantitative Pharmacology

作　　者：张进华[1] 彭文星 董婧[3,4] 刘晓芹 焦正 ZHANG Jin-hua;PENG Wen-xing;DONG Jing;LIU Xiao-qin;JIAO Zheng(Department of Pharmacy,Fujian Medical University Union Hospital,Fuzhou 350001,China;Department of Pharmacy,Beijing Anzhen Hospital,Beijing 100029,China;Department of Pharmacy,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Phar-macy,Shanghai Gongli Hospital,The Second Military Medical University,Shanghai 200135,China;School of Pharmacy,Fndan University,Shanghai 201203,China)

机构地区：[1]福建医科大学附属协和医院药学部,福州350001 [2]首都医科大学附属北京安贞医院药事部,北京100029 [3]复旦大学附属华山医院药剂科,上海200040 [4]中国人民解放军第二军医大学附属公利医院药剂科,上海200135 [5]复旦大学药学院,上海201203

出　　处：《中国药学杂志》2018年第19期1703-1708,共6页Chinese Pharmaceutical Journal

基　　金：留学回国人员科研启动项目资助(2015B001);福建省科技计划引导性项目资助(2018Y0037);上海市卫生计生系统重要薄弱学科建设计划项目资助(2016ZB0301-01)

摘　　要：目的介绍华法林个体化给药的两种常用计算方法——多元线性回归法(MLR)和最大后验贝叶斯法(MAPB),为临床指导华法林的个体化给药提供参考。方法介绍MLR和MAPB在华法林精准给药中的原理,以及实现MLR和MAPB的计算工具,并通过5个华法林个体化给药的典型案例,重点介绍了MAPB计算工具的功能,包括制定华法林初始给药方案、调整给药方案以及其在特殊场景中的应用。结果与结论 MLR计算简单,但一般只可用于制定初始给药方案,无法进行剂量调整,临床应用受到了一定的限制。应用MAPB可制定个体化的华法林给药方案并可根据国际标准化比值(INR)进行剂量调整,预测误差小,还可用于判断患者用药依从性、指导停药时间等特殊情况,灵活性更好,可作为有效的临床辅助工具大力推广,应用前景广阔。OBJECTIVE To introduce two commonly used algorithms for warfarin individualized medication multiple regres- sion analysis （MRA）and maximum a posterior Bayesian （MAPB） , and provide reference for individualized medication of warfarin in clinical practice. METHODS The principles of MRA and MAPB for warfarin individualized medication, as well as the decision sup- port tools to realize MRA and MAPB, were introduced. The function of MAPB tool, including formulating an initial dosage regimen, adjusting the regimen and its application in special clinical situations, was described by five typical cases. RESULTS AND CON- CLUSION MLR is simple to calculate, however, it can only be used to formulate the initial dosage regimen and dose adjustment cannot be carried out, which limits it clinical application in a certain extent. The application of MAPB can not only develop individual- ized medication of warfarin and adjust dose according to international normalized ratio（INR） with satisfactory prediction performance, but also be applied in special cases with better flexibility, such as judging medication adherence and instructing withdrawal. It could serve as an effective decision support tool to be promoted vigorously, which has a promising prospect.

关 键 词：华法林 多元线性回归法 最大后验贝叶斯法 个体化给药 

分 类 号：R969.1[医药卫生—药理学]