专项整治前后结核患者肝损伤及药物使用费用对比分析  

Analysis of anti-tuberculosis drug induced liver injury and its drug use cost in the hospital before and after the special rectification

作　　者：李红丽 文丹丹 贝承丽 高利臣[1,2] 彭喜旭 LI Hongli;WEN Dandan;BEI Chengli;GAO Lichen;PENG Xixu(School of Life Science,Hunan University of Science and Technology,Xiangtan 411201,Hunan,China;Department of Pharmacy,Cancer Institute,PhaseⅠClinical Trial Centre,Changsha Central Hospital Affiliated to University of South China,Changsha 410004,Hunan,China)

机构地区：[1]湖南科技大学生命科学学院,湖南湘潭411201 [2]南华大学附属长沙中心医院药学部,长沙市肿瘤研究所,Ⅰ期临床研究中心,湖南长沙410004

出　　处：《中国临床药理学与治疗学》2019年第9期1030-1036,共7页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：中国结核病临床试验合作中心(CTCTC)科研基金项目(2017KYJJ008);湖南省科技重点研发计划项目(2016SK2066);湖南省中医药科研计划(201940);长沙市科技计划(kq1801144);长沙市中心医院科研重点项目(YNKY201901);湖南省高层次卫生人才“225”工程项目

摘　　要：目的:分析护肝药物专项整治对某院住院结核患者药物性肝损伤、护肝药物使用种类及药物使用费用影响,以减轻患者药物使用经济负担,促进临床护肝药物合理使用。方法:整理某院2013年(整治前1 678例)和2015年(整治后1 828例)肺科医院某结核病区全年住院患者病历资料,对患者入院前、住院中与出院时抗结核药所致药物性肝损伤(ATB-DILI)数据进行统计分析,并从该病区随机抽取2013年9月份(整治前116例)和2015年9月份(整治后108例)住院患者病历资料,对整治前后护肝药物使用种类、治疗药物及护肝药物费用数据进行统计分析。结果:专项整治后,该病区结核患者发生ATB-DILI例数较整治前、入院前与出院时及住院中与出院时并无明显增加(χ2=2.52,P=0.112;χ2=0.18,P=0.673),此外,性别与高危因素分层分析也未发现有显著差异(P>0.05);然而护肝药物剂型构成比有显著变化,注射剂型减少明显(P<0.001);男性、≤12岁、>12和<60岁患者人均护肝药物使用种类数均低于整治前(P=0.002,P=0.034和P=0.014),人均护肝药物使用种类数减少0.40种,减少了24.69%(P=0.001);人均治疗药物费用减少2 099.67元,减少了33.19%(P=0.004),其中,人均护肝药物费用减少931.69元,减少了79.38%(P<0.001)。结论:护肝药物专项整治没有增加患者发生ATB-DILI风险,却显著减少了患者护肝药物使用种类和费用,护肝药物专项整治在保证结核患者抗结核治疗安全性同时,减轻了患者药物费用负担。AIM:To analyze the effects of the special rectification of liver protecting drugs on anti-tuberculosis drug induced liver injury(ATB-DILI),types of liver-protecting drugs and drug use costs of tuberculosis patients in a hospital,so as to reduce the economic burden of drug use and promote the rational use of clinical liver-protecting drugs.METHODS:The medical records of hospitalized patients in a tuberculosis ward of a pulmonary hospital in 2013(1 678 cases before rectification)and 2015(1 828 cases after rectification)were collected.The ATB-DILI data before admission,during admission and at discharge were statistically analyzed.The medical records of hospitalized patients in September 2013(116 cases before rectification)and September 2015(108 cases after rectification)were randomly sampled from the ward.Statistical analysis was conducated on the types of liver-protecting drugs,the cost of therapeutic drugs before and after rectification of liver-protecting drugs.RESULTS:After rectification,number of ATB-DILI cases in tuberculosis patients in this ward did not significantly increase(χ2=2.52,P=0.112;χ2=0.18,P=0.673)as compared with that before rectification,and there was no significant difference between gender and risk factors(P>0.05);the proportion of liver-protective drugs was significantly changed,and the proportion of injections was significantly reduced(P<0.001).The number of types of liver-protecting drugs used per capita in male patients(<12 years old,>12 years old and<60 years old)was lower than that before rectification(P=0.002,P=0.034 and P=0.014),the number of types of liver-protecting drugs used per capita decreased by 0.40,24.69%(P=0.001),and the cost of treatment drugs per capita decreased by 2 099.67 CNY,33.19%(P=0.004),of which,the cost of liver-protecting drugs per capita decreased by 931.69 CNY,or by 79.38%(P<0.001).CONCLUSION:The special rectification of liver protecting drugs does not increase the risk of ATB-DILI,but significantly reduces the types and costs of liver protecting drugs.The spec

关 键 词：护肝药物专项整治 结核患者 抗结核药物性肝损伤 药物费用 

分 类 号：R521[医药卫生—内科学]