运用倾向性评分匹配法评价真实世界抗菌药物不同厂家制剂的治疗效果——以万古霉素为例

Using PSM Method to Evaluate the Therapeutic Effect of Different Manufacturers of Antibiotics in the Real World——Taking Vancomycin as An Example

目的运用倾向性评分匹配法(PSM)评价国产与进口万古霉素治疗效果,旨在为临床抗菌药物的合理使用提供依据。方法收集整理广西医科大学第一附属医院2020年1—12月收治的1416例使用万古霉素住院患者病历资料,其中符合条件病历288例。将患者分为国产组(n=78)与进口组(n=210),以治疗实际效果作为结局指标(因变量),以白细胞计数是否下降、民族、体重指数(BMI)等9个指标作为协变量,评价国产万古霉素与进口万古霉素临床治疗效果。结果运用PSM匹配后,共142例患者成功匹配,其中进口组71例,国产组71例,所有指标均匹配平衡(P>0.05)。匹配后,万古霉素进口组有效率高于国产组(P<0.05)。并且Logistic回归分析结果显示,万古霉素进口组受影响因素数量低于国产组(1∶2),其中万古霉素进口组年龄差异有统计学意义(P<0.05);国产组民族、吸烟史2个指标差异有统计学意义(P<0.05)。结论万古霉素进口组治疗效果可能要优于国产组,且稳定性更高。

Objective To evaluate the therapeutic effect of domestic and imported vancomycin, which aims to provide a basis for the rational use of clinical antibacterial drugs,by using the propensity score matching method(PSM). Methods The medical records of 1 416 hospitalized patients treated with vancomycin in the First Affiliated Hospital of Guangxi Medical University from January to December 2020 were collected, including 288 eligible medical records. The patients were divided into domestic group(n=78) and imported group(n=210). With the actual effect of treatment as the outcome index(dependent variable), and nine indicators such as leukocyte decline, ethnicity, BMI as covariates, the clinical treatment effect of domestic vancomycin and imported vancomycin was evaluated. Results After PSM matching, 142 patients were successfully matched, including 71 cases in the imported group and 71 cases in the domestic group. All indicators were matched and balanced(P>0.05). After matching, the effective rate of vancomycin imported group was higher than that of domestic group(P<0.05). And the logistic regression results showed that the number of affected factors in the vancomycin import group was lower than that of the domestic group(1∶2), and the age of the vancomycin import group was statistically significant(P<0.05). There were statistically significant differences in the two indicators of ethnicity and smoking history in the domestic group(P<0.05). Conclusion The therapeutic effect of the imported vancomycin group may be better than that of the domestic group, and the stability is higher.