9个城市112家医院门急诊患者孕激素类药物临床应用的处方大数据分析

Big Data Analysis of Clinical Application of Progestogens in Outpatient and Emergency Patients from 112 Hospitals in 9 Cities

目的:通过大数据分析手段,探索孕激素类药物在我国门急诊患者中的应用现状及使用合理性,为促进临床合理用药、保障患者用药安全提供支持。方法:提取2016—2020年9个城市112家样本医院门急诊患者所用孕激素类药物信息,统计国内孕激素类药物的整体用药现状,分析典型疾病的孕激素类药物使用构成与选择合理性,探讨孕激素类药物超适应证用药问题。结果:最终纳入540184例患者处方,含605233条孕激素类药物使用记录。除2020年可能受新型冠状病毒感染疫情影响外,孕激素类药物整体使用人次、用药频度呈增长趋势,高价孕激素类药物的限定日费用自2017年起有明显下降。黄体酮、地屈孕酮在临床治疗中的应用最为广泛,后者临床选择趋势增长明显。孕激素类药物联合使用率为10.9%(58625例)。典型疾病患者使用孕激素类药物有各自特色,基本合理;超适应证用药较为常见,最常见的诊断为子宫内膜息肉、妇科检查、阴道炎。结论:孕激素类药物在我国应用广泛且呈增长趋势,临床应用基本合理,但超适应证用药问题和联合用药依据不足值得关注。未来仍需开展大样本高质量的临床研究,以验证孕激素类药物的使用安全性、有效性和经济性问题。

OBJECTIVE:To probe into the application status and rationality of progestogens in outpatient and emergency patients in China based on big data analysis techniques,so as to provide support for promoting clinical rational drug use and ensuring drug safety for patients.METHODS:Data of progestogen prescriptions from 2016 to 2020 were extracted from 112 hospitals in 9 cities.The application status of progestogens in China was analyzed,the composition and selection of progestogen for typical diseases were analyzed,and the problem of off-label indications was discussed.RESULTS:Totally 540184 prescriptions were enrolled,including 605233 records of progestogens.Except for 2020,which may be affected by COVID-19,the overall use and frequency of progestogens were on the increase,and the defined daily cost of high-priced progestogens decreased significantly since 2017.Progestin and dydrogesterone were the most widely used,and the latter had an obvious trend of increasing in clinical selection.Drug combination of progestogens were common(10.9%,58625 cases).The applications of progestogens in patients with typical diseases had their own characteristics,and the drug selection was basically rational.Off-label indications were also common,and the most common diagnoses were endometrial polyps,gynecological examination and vaginitis.CONCLUSIONS:Progestogens are widely used in China and show an increasing trend,and the clinical application is basically reasonable,yet the problem of off-label indication drug use and the lack of evidence for drug combination deserve attention.In the future,it is still necessary to carry out high-quality clinical studies with large samples to verify the safety,effectiveness and economy of the use of progestogens.