药物利用评价法和药物利用评估法在慢性乙型肝炎药物治疗中的应用研究

Study on the application of DUR and DUE in the treatment of chronic hepatitis B

目的:探讨建立适合慢性乙型肝炎(CHB)患者的药物利用评价程序。方法:回顾性查阅嘉兴某医院2014-2015年CHB住院患者的相关资料,采用药物利用评价(DUR)法和药物利用评估(DUE)法,对患者药物利用指数(DUI)、评价指标和诊断、治疗药物监测及临床治疗结果进行分析。结果:纳入DUI分析药物26种,分别为抗炎保肝药18种,免疫调节药1种和抗病毒药5种;用药频度前3位的分别是注射用还原型谷胱甘肽、注射用丁二磺酸腺苷蛋氨酸和恩替卡韦片;7种药物DUI>1,13种药物DUI=1,6种药物DUI<1。DUE结果显示,所有患者均确定病原学分型及临床分期,仅有9例确定病理学分期;治疗过程监测指标中,肝功能监测率为67.20%;药品不良反应发生率最高的是乏力;165例(88.71%)患者经治疗后临床症状得到改善。结论:联合DUR和DUE法可以更全面地评价慢性乙型肝炎患者的用药情况,临床应根据相关指南规范诊疗。

AIM： To establish drug utilization review（ DUR） procedure suitable for patients with chronic hepatitis B（ CHB）. METHODS： A retrospective review was performed with the related information of Jiaxing hospital in 2014- 2015 of hospitalized patients with CHB. DUR and drug utilization evaluation（ DUE） were applied to analyze the drug utilization index（ DUI）,the evaluation index and diagnosis,therapeutic drug monitoring and clinical treatment results. RESULTS： 26 DUI analysis drugs as 18 kinds of liver-protective medicine,1 kind of immunomodulatory drug and 5 kinds of antiviral drugs were included. Top 3 of the most used medicine are reduced glutathione for injection,injection with succinic acid adenosine methionine and entecavir. 7 kinds with DUI above 1,13 kinds with DUI equal to 1,and 6 kinds with DUI below 1. The outcomes of DUE showed that all patients were determined for pathogenic credit type and clinical stage,only 9 cases were determined for the pathologic stage. Of all the monitored indexes,liver function was monitoring at a rate of 67. 20%. The highest incidence of adverse drug reactions was fatigue. Clinical symptoms were improved in 165 patients（ 88. 71%） after treatment. CONCLUSION： Combined DUR and DUE methods can be more comprehensive in evaluating drug utilization of the patients with chronic hepatitis B,while relevant guidelines should be followed for clinical application.