9城市老年患者使用他汀类药物潜在药物相互作用分析

Potential drug-drug interactions with statins among elderly patients in 9 cities in China

目的对老年患者处方中他汀类药物的潜在药物相互作用进行分析。方法抽取2016年至2021年9座城市160余家医院使用他汀类药物的老年患者门诊处方,根据Lexicomp药物相互作用数据库筛查存在的D类及X类的药物相互作用。同时根据最新版他汀类药物说明书中针对合并用药推荐的每日最大剂量,筛选超出该推荐剂量的处方。使用sql server 2019及R 4.2软件进行数据处理、Logistic回归及其他统计学分析。结果共收集2733777例次门诊处方,涉及7种他汀类药物,筛查出潜在相互作用37584例次,整体发生率为1.38%。多因素二元Logistic回归分析显示,相对于男性,女性(OR=1.18,95%CI 1.16~1.21,P<0.001)的潜在药物相互作用风险更高;相对于65~74岁患者,75~84岁(OR=1.03,95%CI 1.01~1.05,P<0.05)患者风险略增加,85~94岁(OR=0.96,95%CI 0.93~0.99,P<0.05)患者风险略降低,95岁及以上患者差异无统计学意义;相对于合用2种药物的患者,随着合用药数量的增加风险增加:3种(OR=2.23,95%CI 2.12~2.34,P<0.001),4种(OR=3.24,95%CI 3.10~3.40,P<0.001),5种(OR=4.15,95%CI 3.96~4.34,P<0.001),5种以上(OR=5.47,95%CI 5.23~5.72,P<0.001)。结论老年患者使用他汀类药物时存在发生潜在药物相互作用的风险,临床工作者需要给予足够的重视。

Objective To analyze the potential drug-drug interactions with statins among elderly patients.Methods We collected outpatient prescriptions of elderly patients using statins from more than 160 hospitals in 9 cities between 2016 to 2021.We screened class D and class X drug-drug interactions with Lexicomp database.We also screened prescriptions whose dosage of statins was beyond the recommended amounts.After that,data processing,Logistic regression and other statistical analyse were performed by sql server 2019 and R 4.2 software.Results Totally 2733777 prescriptions were collected and 37584(1.38%)potential interactions concerning 7 statins were found.The multivariate binary Logistic regression showed that females(OR=1.18,95%CI 1.16~1.21,P<0.001)had higher risks of potential drug-drug interactions compared to males.Patients at 75~84 years(OR=1.03,95%CI 1.01~1.05,P<0.05)had a slightly increased risk,while at 85~94 years(OR=0.96,95%CI 0.93~0.99,P<0.05)patients had a slightly decreased risk,as compared with the 65~74 age group.The risks in patients aged 95 and above showed no statistical differece.For patients taking 2 or more combination drugs,risks increased with the number of combination drugs:3 drugs(OR=2.23,95%CI 2.12~2.34,P<0.001),4 drugs(OR=3.24,95%CI 3.10~3.40,P<0.001),5 drugs(OR=4.15,95%CI 3.96~4.34,P<0.001),and more than 5 drugs(OR=5.47,95%CI 5.23~5.72,P<0.001).Conclusion Risk of potential drug-drug interactions exist when elderly patients take statins,together with other drugs.