中国六城市医院阿尔茨海默病用药现状分析

Analysis of medication situation of Alzheimer＇s disease on hospitals of six cities in China

目的：了解近年中国六城市医院对阿尔茨海默病（AD）患者进行药物治疗的现状。方法数据来自《医院处方分析合作项目》中的北京、天津、上海、广州、成都和杭州50家医院，2012至2014年每家医院每年随机抽取40 d 门诊、急诊处方和住院医嘱，提取诊断为 AD 的用药信息，用Visual FoxPro 8.0数据库和 SPSS 22.0软件进行统计分析。结果六城市 AD 患者为59891例次，患病高峰在75~89岁，占 AD 患者总例次的66.9%（40096例次）。应用一线治疗药物胆碱酯酶抑制剂（ChEI）和 N-甲基-D-天冬氨酸（NMDA）受体拮抗剂占 AD 总例次的46.5%（27827/59891），痴呆行为和精神症状处理（ BPSD）的药物占26.4%（15811/59891），神经营养剂占15.1%（9043/59891），干预药物占11.7%（7007/59891）。AD 患者3年间单用 ChEI、单用 NMDA 受体拮抗剂、ChEI 与 NMDA 受体拮抗剂联用构成比差异均无统计学意义（均 P ＞0.05）。ChEI 与 NMDA 受体拮抗剂联用复合年增长率为69.6%。AD 患者用药按例次计排在前3位的药物分别是多奈哌齐（14254例次）、美金刚（12278例次）和奥氮平（4612例次）。AD 患者处方总金额为2012.4万元，前15位品种中，一线治疗药物为912.9万元（45.4%），BPSD 治疗药物为153.8万元（7.6%），神经营养剂为127.8万元（6.4%），干预药物为43.3万元（2.2%）。结论中国六城市医院医师对患者治疗遵循欧洲和中国 AD 治疗指南，实行多靶点药物联用方案，用药基本合理，但也存在为患者开具一些疗效不确切的药物、导致患者经济负担过重的问题。

Objective To understand the medication situation of Alzheimer＇s disease（AD）of six cities in China Methods The data were from 50 hospitals of six cities（ including Beijing,Tianjin, Shanghai,Guangzhou,Chengdu and Hangzhou） in China which involved in the Hospital Prescription Analysis Cooperative Project. Prescriptions from Department of Outpatient and Emergency,doctor＇s orders of inpatients in 40 days in each hospital in each year from 2012 to 2014 were selected randomly. The information of medication use about AD was extracted and analyzed using software of Visual FoxPro 8. 0 and SPSS 22. 0. Results There were 59 891 AD patients in six cities. The patients＇ prevalence peak was in 75 to 89 years,accounted for 66. 9% of the total cases of AD patients（40 096 patients）. Application of cholinesterase inhibitors（ ChEI）and N-methyl-D-aspartate（ NMDA）receptor antagonist accounted for 46. 5% of the total cases of AD patients（27 827 / 59 891）,behavioral and psychological symptoms of dementia（BPSD）accounted for 26. 4%（15 811 / 59 891）,neural nutrition agent accounted for 15. 1%（9 043 / 59 891）,prevention of AD accounted for 11. 7% （7 007 / 59 891）. There were no significant differences in constituent ratios of ChEI use alone,NMDA receptor antagonist use alone,or ChEI combined with NMDA receptor antagonist treatment in AD patients in the 3 years（P 〉 0. 05）. The compound annual growth rate was 69. 6% of ChEI combined with NMDA receptor antagonist treatment. The top 3 drugs in AD patients were donepezil（ 14 254 patients）,memantine（ 12 278 patients）,and olanzapine（ 4 612 patients）. Total amount of AD patients＇ prescriptions was 20. 124 million yuan,of the top 15 drugs according to the cost for AD treatment,the cost of first-line therapy was 9. 129 million yuan（45. 4% ）,the＆amp;nbsp;cost of BPSD was 1. 538 million yuan（7. 6% ）,the cost of neural nutrition agent was 1. 278 million yuan （6. 4% ）,and the cost of prevention of AD was 0. 433 million yuan（2. 2% ）. Conclusions Chinese doctors in six cities could follow European and Chinese AD treatment guidelines and implement multi-target drug combination regimen for AD patients. The use of drugs in this AD patients was basically reasonable. But there were some problems in which doctors prescribed ineffective drugs,leading to heavy economic burden in AD patients.