痛风达标治疗人群用药真实情况分析:多中心真实世界研究结果  

Analysis of the real situation of medication in the population with gout achieving T2T indicators:a multicentre real-world study

作　　者：高维琴[1] 龚学忠[2] 章渊源 杜星辰 姜平 关凤媛 鲁盈[5] 苏晓[6] 姜洪泽 李鸿斌 方勇飞 赵恒立 彭江云[11] 高明利 苏励[13] 何方 陶庆文[15] 胡春蓉[16] 李鹏 李泽光[18] 朱跃兰[19] 古英[20] 张明[21] 汪荣盛[1] 姜婷[1] 杨晓凌 朱琦[1] 姜泉[22] 张剑勇[23] 范晓蕾 薛愉 何东仪[1] Gao Weiqin;Gong Xuezhong;Zhang Yuanyuan;Du Xingchen;Jiang Ping;Guan Fengyuan;Lu Ying;Su Xiao;Jiang Hongze;Li Hongbin;Fang Yongfei;Zhao Hengli;Peng Jiangyun;Gao Mingli;Su Li;He Fang;Tao Qingwen;Hu Chunrong;Li Peng;LI Zeguang;Zhu Yuelan;Gu Ying;Zhang Ming;WangRongsheng;Jiang Ting;Yang Xiaolin;Zhu Qi;Jiang Quan;Zhang Jianyong;Fan Xiaolei;Xue Yu;He Dongyi(Department of R heumatology and Immunology,Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Department of Nephrology,Shanghai Municipal Hospital of Traditional Chinese Medicine,Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;Department of Rheumatology and Immunology,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;Department of Rheumatology and Immunology,Yingkou Hospital of Traditional Chinese Medicine of Liaoning Province,Yingkou 115002,China;Department of Rheumatology and Immunology,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China;Department of Rheumatology and Immunology,Shanghai Manicipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;Department of Rheumatology and Immunology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 750306,China;Department of Rheumatology and Immunology,Shandong Haiyang Hospital of Traditional Chinese Medicine,Haiyang 265199,China;Department of Rheumatology and Immunology,Chongqing Southwest Hospital,Chongqing 400038,China;Department of Rheumatology and Immunology,Yantai Hospital of Traditional Chinese Medicine of Shandong Province,Yantai 264013,China;Department of Rheumatology and Immunology,Yunnan Hospital of Traditional Chinese Medicine,Kunming 650021,China;Department of Rheumatology and Immunology,Liaoning Hospital of Traditional Chinese Medicine,Shenyang 110033,China;Department of Rheumatology and Immunology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China

机构地区：[1]上海中医药大学附属光华中西医结合医院风湿免疫科,上海200052 [2]上海中医药大学附属市中医医院肾病科,上海200074 [3]复旦大学附属华山医院风湿免疫科,上海200040 [4]辽宁省营口市中医院风湿免疫科,营口115002 [5]浙江省立同德医院风湿免疫科,杭州310012 [6]上海中医药大学附属市中医医院风湿免疫科,上海200071 [7]内蒙古医科大学附属医院风湿免疫科,呼和浩特750306 [8]山东省海阳市中医医院风湿免疫科,海阳265199 [9]重庆西南医院风湿免疫科,重庆400038 [10]山东省烟台市中医医院风湿免疫科,烟台264013 [11]云南省中医医院风湿免疫科,昆明650021 [12]辽宁省中医院风湿免疫科,沈阳110033 [13]上海中医药大学附属龙华医院风湿免疫科,上海200032 [14]上海市长宁区新泾镇街道社区卫生服务中心,上海200336 [15]中日友好医院风湿免疫科,北京100029 [16]重庆市第九人民医院风湿免疫科,重庆400799 [17]新疆维吾尔自治区中医医院心内科,乌鲁木齐830099 [18]黑龙江中医药大学附属第一医院风湿免疫科,哈尔滨150040 [19]北京中医药大学东方医院风湿免疫科,北京京100078 [20]四川省绵阳市中医医院风湿免疫科,绵阳日621053 [21]上海中医药大学附属岳阳中西医结合医院皮肤科,上海2200083 [22]中国中医科学院广安门医院风湿免疫科,北京100053 [23]广东省深圳市中医院风湿免疫科,深圳518005

出　　处：《中华风湿病学杂志》2023年第6期361-367,共7页Chinese Journal of Rheumatology

基　　金：国家中医药管理局区域中医(专科)诊疗中心建设项目(2018-2022);国家中医药管理局国家中医药循证医学研究建设项目;上海市卫生健康委员会/上海市进一步加快中医药传承创新发展三年行动计划项目[ZY(2021-2023)-0302];上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划(SHDC2020CR1013B)。

摘　　要：目的通过真实世界方法研究,运用数据挖掘探索痛风达标治疗人群的治疗特点和规律,并评价其安全性。为临床痛风的达标、安全治疗及管理提供指导依据。方法本研究基于医院信息系统(HIS)中临床真实世界数据,收集多家医院风湿免疫科2015年1月至2021年12月以痛风为诊断的门诊治疗患者,将其在门诊治疗中产生的临床数据建立数据库。使用SPSS及Excel软件,采取频数分析、聚类分析、因子分析,总结经治疗后达标的痛风患者的治疗措施特点及规律。记录治疗过程中的不良事件(AE)发生情况。结果共纳人痛风患者3287例,随访诊次9861个。其中治疗后血清尿酸(SUA)达标诊次占比为7.01%(691/9861),关节疼痛表现视觉模拟评分(VAS)达标占比为59.81%(5898/9861)。治疗后SUA控制达标诊次691个,降尿酸药物中使用频次最高的是非布司他,其次为苯溴马隆。高频治疗措施中,使用系统聚类分析的方法进行挖掘分析,发现6组治疗方案:①中药饮片-中医技术-生活干预措施-中成药,②阿魏酸哌嗪片-NSAIDs,③别嘌醇-碳酸氢钠,④苯溴马隆,⑤激素-秋水仙碱,⑥非布司他。同时采取因子分析,提取5个公因子。关节疼痛表现VAS评分控制达标诊次共5898个,使用频次最高的控制症状药物为NSAIDs。高频治疗措施中,使用系统聚类分析的方法进行挖掘,发现5组治疗方案:①中成药-中药饮片-中医技术-生活干预措施,②NSAIDs-秋水仙碱-激素,③别嘌醇,④苯溴马隆,⑤非布司他。整体治疗过程中共有59例AE发生。结论本次研究显示痛风患者的SUA达标率很低,关节炎控制欠佳,治疗中降尿酸药物使用率偏低,降尿酸治疗和抗炎处方模式均与国际指南存在较大差异,因此需加强痛风患者规范管理。同时生活干预措施在有限的达标人群治疗方案中均占有一席之地,需要进一步深入探索。Objective To explore the therapeutic characteristics of population with gout achieving treat-to-target(T2T)indicators through real-world research and evaluate their safety.Methods A total of 3287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces,municipalities,and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study.The database included patients'general information,disease characteristics,and clinical application of traditional Chinese and Western medicine treatment measures.SPSS and Excel software were used for data analysis.Frequency analysis,cluster analysis,and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment.The occurrence of adverse events(AE)was recorded during treatment.Results After treatment,691 visits(7%)achieved the serum urate(SUA)target,and the most frequent use of urate-lowering therapy(ULT)was febuxostat,followed by benzbromarone.The most common treatment options were following:Group I:traditional Chinese medicine(TCM)decoction-TCM external treatment-physical exercise-proprietary Chinese medicine;Group I:ferulic acid-nonsteroidal anti-inflammatory drugs(NSAIDs);Group II:allopurinolsodium bicarbonate-benzbromarone;Group IV:glucocorticoid-colchicine;Group V:febuxostat.A total of 5898 visits(60%)chieved manifestations of joint pain VAS scores target,and the most frequently used drug to control joint symptoms was NSAIDs.The frequency of use of drugs to control joint symptoms were 2118 times(usage rate reached 35.9%),while the frequency of ULT were 2504 times(usage rate reached 42.5%),which was higher than the joint symptom control drug.The most common treatment options were following:Group Ⅰ:proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise;Group Ⅱ:NSAIDscolchicine hormones;Group Ⅲ:allopurinol,Group Ⅳ:benzbromarone;Group Ⅴ:febuxostat.A tot

关 键 词：痛风 尿酸 达标治疗 真实世界 

分 类 号：R589.7[医药卫生—内分泌]