摘要
目的 分析糖尿病综合管理中药物相互作用(DDI)的特点及影响因素.方法 使用Lexi-InteractTM数据库,筛选糖尿病综合管理中降血糖药、降血压药、调血脂药、减重药的DDI,根据严重程度分为X级(避免联用)、D级(考虑调整治疗)、C级(需监控治疗)、B级(无须调整)、A级(无DDI);收集上海某三级甲等医院 2 型糖尿病并心肌梗死患者的病例资料,并根据患者的DDI数量分为低DDI组(<5 组DDI)和高DDI组(≥5 组DDI),分析DDI的特点及影响因素.结果 共纳入 109 种药物,其中降血压药、降血糖药、调血脂药、减重药分别有 57 种、32 种、19 种、1 种,DDI分别有 5 091 组、1 086 组、723 组、15 组.除减重药外,其余 3 种药物DDI总数最多的分别为钙通道阻滞剂(CCB)、磺脲类药物、他汀类药物;X级药物DDI数量排名前 3 的药物分别为他汀类药物、CCB类药物及β受体拮抗药.共纳入患者 69 例,其中低DDI组和高DDI组分别有 26 例、43 例,影响患者DDI总数的危险因素包括患者合并用药数量、慢性肾脏病(CKD)1-3 期,以及糖化血红蛋白、糖化白蛋白和空腹血糖水平(P<0.05).结论 控制合并用药数量并保持良好的血糖水平,有利于减少糖尿病综合管理中的DDI.
Abstract
Objective To analyze the characteristics and influencing factors of drug-drug interactions(DDIs)in comprehensive management of diabetes mellitus(DM).Methods The Lexi-InteractTM database was used to screen DDIs of hypoglycemic,antihypertensive,blood lipid-regulation and weight-loss drugs in the comprehensive management of DM.Based on the severity,the DDIs were divided into the grade X(avoiding combined use),grade D(considering adjusting treatment),grade C(requiring monitoring treatment),grade B(not requiring adjustment),grade A(without DDI).The data of patients with diabetes mellitus type 2(T2DM)and myocardial infarction in a tertiary-A hospital in Shanghai were collected,the patients were divided into the low-DDIs group(<five cases of DDIs)and high-DDIs group(≥five cases of DDIs),the characteristics and influencing factors of DDIs were analyzed.Results A total of 109 drugs were included,including 57,32,19,one antihypertensive,hypoglycemic,blood lipid-regulation and weight-loss drugs,with 5 091,1 086,723,15 cases of DDIs respectively.Except for weight-loss drugs,the other three drugs with the most cases of DDIs were calcium channel blockers(CCBs),sulfonylureas,statins,respectively.The top three drugs of grade X with many cases of DDIs were statins,CCBs and β receptor antagonists.A total of 69 patients were included,with 26 in the low-DDIs group and 43 in the high-DDIs group,respectively.The risk factors affecting the cases of DDIs in patients included the number of combined medications,chronic kidney disease(CKD)of stages one to three,glycated hemoglobin,glycated albumin and fasting blood glucose(P<0.05).Conclusion Rational number of combined medications and normal blood glucose level are beneficial to reduce the DDIs in the comprehensive management of DM.
基金项目
上海市卫生健康委卫生行业临床研究专项青年项目(20204Y0011)
国家科技期刊平台
NSTL
维普
万方数据