2015—2020年湖南省医疗机构肾毒性药物用药情况分析  

Use of nephrotoxic drugs in medical institutions in Hunan from 2015 to 2020

作　　者：尹文俊[1] 周凌云[1] 周颖玉 周光亮 朴慧玲 刘昆 谷旭瑞 胡灿[1] 谢悦良[1] 左笑丛[1] YIN Wen-jun;ZHOU Ling-yun;ZHOU Ying-yu;ZHOU Guang-liang;PIAO Hui-ling;LIU Kun;GU Xu-rui;HU Can;XIE Yue-liang;ZUO Xiao-cong(The Third Xiangya Hospital,Central South University,Changsha 410013;Science and Technology Development Center of Chinese Pharmaceutical Association,Beijing 100020;Zunyi Medical University,Zunyi Guizhou 563006)

机构地区：[1]中南大学湘雅三医院,长沙410013 [2]中国药学会科技开发中心,北京100020 [3]遵义医科大学,贵州遵义563006

出　　处：《中南药学》2022年第2期456-462,共7页Central South Pharmacy

基　　金：国家自然科学基金项目(No.81973400,No.82104305);湖南省自然科学基金项目(No.2020JJ5792,No.2021JJ40957);中南大学湘雅临床大数据系统建设项目(No.76)。

摘　　要：目的分析2015—2020年湖南省医疗机构肾毒性药物的使用情况,为临床合理用药提供数据支持。方法以全国1026家中国药学会医药经济信息网(CMEI)网员医疗机构药品采购数据库为基础,选取肾素-血管紧张素系统(RAS)抑制药、全身用抗细菌药、全身用抗病毒药、利尿剂、免疫抑制剂、抗肿瘤药和含碘造影剂中使用金额和用量排名前20位,且肾脏损伤不良反应发生率≥1%的药物作为肾毒性药物进行研究,分析2015—2020年常见肾毒性药物类别在湖南省和全国的年均使用金额和用量及药物年均金额占比、年均金额占比差值、年均用量占比、年均用量占比差值和使用人次。结果最终纳入21个药物作为肾毒性药物进行分析,2015—2020年湖南省年均金额占比和用量占比都高于全国平均水平的药品有碘海醇、呋塞米、坎地沙坦酯、甲氨蝶呤、美罗培南、吉西他滨和顺铂,最高者为碘海醇;湖南省年均使用人次数排前五者分别为碘海醇、呋塞米、碘佛醇、坎地沙坦酯和阿德福韦酯,全国年均使用人次排前五者分别为呋塞米、坎地沙坦酯、阿德福韦酯、碘海醇和氢氯噻嗪;湖南省次高渗碘造影剂的年均金额占比和/或年均用量占比高于全国平均水平,袢利尿药、保钾利尿药和血管升压素V_(2)受体拮抗剂的年均用量占比也高于全国平均水平。结论湖南省医疗机构使用碘海醇、呋塞米等7种肾毒性药物的年均金额和年均用量占比高于全国平均水平,以碘海醇使用金额和使用量占比位列榜首,如何在使用这些药物时降低其肾毒性的发生风险仍需深入研究。Objective To analyze the use of nephrotoxic drugs in medical institutions in Hunan from 2015 to 2020,and provide data support for clinical rational use of drugs.Methods Based on the drug purchase database of 1026 medical institutions of Chinese Medical Economic Information Network(CMEI),we selected the top 20 cost and quantity of drugs acting on renin angiotensin system(RAS),systemic anti-bacterial drugs,systemic antiviral drugs,diuretics,immunosuppressants,antineoplastic drugs and iodine containing contrast agents,and the drugs with an adverse reaction rate of kidney injury≥1%were used as nephrotoxic drugs for research.We analyzed the average annual cost and quantity of common nephrotoxic drugs,the proportion of the average annual cost,the difference in the proportion of the average annual cost,the proportion of average annual quantity,the difference in proportion of the average annual quantity,and the user-times of each nephrotoxic drug in Hunan and China from 2015 to 2020.Results Totally 21 drugs were included as nephrotoxic drugs for the analysis.The average cost and dosage ratio of iohexol,furosemide,candesartan cilexetil,methotrexate,gemcitabine,meropenem,and cisplatin in Hunan from 2015 to 2020 were higher than the national average level,with iohexol being the highest.The top 5 user-times drug in Hunan included iohexol,furosemide,voversol,candesartan cilexetil and adefovir dipivoxil.While those of quantity in China covered furosemide,candesartan cilexetil,adefovir dipivoxil,iohexol and hydrochlorothiazide.Proportion of the average annual cost and/or the average annual quantity of sub-hypertonic iodine contrast agents in Hunan were higher than the national average level.Proportion of the average annual quantity of loop diuretics,potassium-sparing diuretics,and vasopressin V_(2) receptor antagonists in Hunan were also higher.Conclusion Compared with the national average level,the average annual cost and the average annual quantity of 7 nephrotoxic drugs in medical institutions in Hunan are higher.The propo

关 键 词：湖南省医疗机构 肾毒性药物 碘海醇 药源性肾损伤 

分 类 号：R978.1[医药卫生—药品]