Change in molecular weight due to important pfatp6 and pfmdr1 polymorphisms and susceptibility to antimalarial drug:Possible role of epigenetic phenomenon

Malaria is an important tropical mosquito borne infection. It is still the present global public health issue. The management of malaria requires antimalarial drugs. The resistance to antimalarial drugs is a very big problem. The genetic variant is proposed to be an important factor affecting susceptibility to antimalarial drug. Here, the authors studied the change in molecular weight due to important pfatp6 and pfmdr1 polymorphisms and further implied the interrelationship with susceptibility to antimalarial drug. The greatest change can be seen in case of G639D(of pfatp6 polymorphism) while the least change can be seen in the case of N1042D(of pfmdr1 polymorphism). The results from some studies imply that there must be other factors that affect the susceptibility to antimalarial drugs. Those factors might be protein conformation factors, epigenetic factors or environmental factors. Further studies on these aspects should be carried out. It is concluded for possible role of epigenetic phenomenon.

Analytic Hierarchy Process for Technological Risks in the Process of Innovative Drug Development in China

Objective To identify the critical risks in the process of innovative drug research and development,and to provide reference for improving the efficiency of innovative drug development and risk control in China.Methods Expert investigation and analytic hierarchy process were used to determine the weights of different risks.Results and Conclusion The research and analysis results showed that the risks at different stages of development had different effects on the success rate of drug development,among which the risk at the drug discovery stage influenced the most.In the drug discovery stage,inappropriate target selection had the greatest impact on the success rate of drug development.The lack of appropriate cell tissue or animal models had the greatest impact on the success rate of drug development from the discovery of a compound to the application for clinical trials.The difference in changes between nonclinical and clinical studies had the greatest impact on the success rate of drug development from early clinical studies to pivotal clinical studies.Incorrect dose selection had the greatest impact on the success rate of drug development from pivotal clinical studies to marketing authorization applications.The biggest impact from the marketing authorization application to the approval stage was inadequate communication with regulators.After investigating the weight of risk factors in the process of innovative drug development based on scientific methods,a new perspective for the risk control of new drug development and improving the research and development efficiency is provided.

Association of the HTR2C-759CT polymorphism and antipsychotic-induced weight gain:a meta-analysis

Background Antipsychotic-induced weight gain(AIWG)is a crucial factor for the medication cessation of patients with schizophrenia.Multiple studies have shown that the functional polymorphism-759 C/T(rs3813929)in the HTR2C promoter region could possibly be correlated with AIWG.Aim To evaluate the genetic association of the HTR2C-759C/T polymorphism and AIWG in patients with schizophrenia with antipsychotic drugs(APDs)administration.Methods Eligible studies were identified by searching the following databases:PubMed,Embase,Web of Science,China Nation Knowledge Infrastructure(CNKI),VIP,Wanfang Data,Chinese Biomedical Literature Database(CBM)and the Airiti Library.The quality of studies was evaluated based on the Newcastle-Ottawa Scale.The pooled OR and 95%Cl were calculated for the dominant(CT/TT/T vs CC/C)mode,and subgroup analyses were performed based on ethnicity,antipsychotic medication and gender;ail statistical analyses were performed using the statistical software STATA V.12.0.Result A total of 17 studies with 3170 patients with schizophrenia were included in our meta-analysis.The result of the meta-analysis has shown that the association between the-759 C/T polymorphism and AIWG is statistically significant(OR 0.34,95%Cl:0.20 to 0.57,z=4.11,p<0.001).The subgroup analyses revealed significant correlations between the-759 C/T polymorphism and AIWG in the Caucasian population(OR 0.33,95%CI:0.14 to 0.77,z=2.55,p=0.011),the Asian population(OR 0.31,95%Cl:0.18 to 0.52,z=4.46,p<0.001),the patients with APDs administration(CT/JTfJ vs CC/C:OR 0.63,95%Cl:0.40 to 1.00,z=1.97,p=0.049)and the patients with atypical antipsychotic drug administration(CT/TT/T vs CC/C:OR 0.21,95%Cl:0.09 to 0.47,z=3.83,p<0.001).The sensitivity analysis showed that the results were stable.Begg's test(after correction z=1.07,p=0.287)and Egger's test(t=-2.41,p=0.029)show that the included articles have no significant publication bias.Conclusion There is a significant genetic association between HTR2C-759C/T and AIWG,and patients with T allele are less likely to have AIWG.

Milk-derived exosomes as a promising vehicle for oral delivery of hydrophilic biomacromolecule drugs

Exosomes,as promising vehicles,have been widely used in the research of oral drug delivery,but the generally low drug loading efficiency of exosomes seriously limits its application and transformation.In this study,we systematically investigated the effects of drug loading methods and physicochemical properties(lipophilicity and molecular weight)on drug loading efficiency of milk-derived exosomes to explore the most appropriate loading conditions.Our finding revealed that the drug loading efficiency of exosomes was closely related to the drug loading method,drug lipophilicity,drug molecular weight and exosome/drug proportions.Of note,we demonstrated the universality that hydrophilic biomacromolecule drugs were the most appropriate loading drugs for milk-derived exosomes,which was attributed to the efficient loading capacity and sustained release behavior.Furthermore,milk-derived exosomes could significantly improve the transepithelial transport and oral bioavailability of model hydrophilic biomacromolecule drugs(octreotide,exendin-4 and salmon calcitonin).Collectively,our results suggested that the encapsulation of hydrophilic biomacromolecule drugs might be the most promising direction for milk exosomes as oral drug delivery vehicles.

Ameliorating Effects of Thyroxine and Atropine in Phosphamidon Intoxicated Chick Embryos

The effects of thyroxine and atropine in ameliorating phosphamidon intoxication in chick embryos was studied. Treatment of phosphamidon significantly enhanced the moriality and abnormalityrates, decreased the average body weights, and cholinesterase activity in chick embryos. When thyroxine was administered to the phosphamidon intoxicated embryos, the above parameters changedsignificantly, indicating an ameliorating effect of thyroxine against phosphamidon intoxication in chick embryos. The combined thyroxine and atropine therapy did not further improve the ameliorating effect. Since in many respects chick embryo development parallels that of mammalian embryos,a short-term use of thyroxine as a protective agent against organophosphate toxicity might be useful

Anti-obesity drugs currently used and new compounds in clinical development

Obesity is a chronic disease which requires treatment. As lifestyle interventions alone hardly ever result in long-term weight loss, pharmacotherapy is an impor-tant adjunct to lifestyle measures to improve the induc-tion and maintenance of weight loss. Owing to the lim-ited options currently available for the pharmacological treatment of obesity, it is imperative to develop new safe compounds. This study aims to review the current medications approved by European Medicines Agency and United States Food and Drug Administration （FDA） for the treatment of obesity, focusing essentially on their benefits and risks, as well as on the new drugs which are presently under clinical trials. Moreover, it lists the anti-obesity agents that have been recently withdrawn from the market. A revision of the scientifc literature was carried out, through a search on Pubmedfor papers published from January 2010 to January2013. Orlistat （Xenical？） is currently the only long-termpharmacotherapy for obesity available in the Europeanmarket, as rimonabant and sibutramine were with-drawn in 2008 and 2010, respectively, due to serious psychiatric and cardiovascular adverse effects. Lorca-serin （Belviq？） and the association of phentermine and topiramate （QsymiaTM） were recently approved by FDA. Orlistat suppresses appetite inhibiting gastrointestinal lipase, being its adverse effects mostly gastrointestinal. Lorcaserin activates 5-HT2C receptors, phentermine is a norepinephrine releasing drug, and topiramate is an anticonvulsivant drug with weight loss properties.

基于加权TOPSIS法的贝米肝素钠注射液药物利用评价

目的建立贝米肝素钠注射液药物利用评价(DUE)标准,并采用加权优劣解距离(TOPSIS)法对贝米肝素钠注射液的使用情况进行评价,为促进其合理使用提供参考。方法以药品说明书为基础,参考相关指南和文献,采用专家咨询法建立贝米肝素钠注射液的DUE标准细则,采用加权TOPSIS法对同济大学附属同济医院2021年6—7月使用贝米肝素钠注射液的住院患者病历进行合理性评价。结果在贝米肝素钠注射液DUE标准中,10个二级指标相对权重系数排名前2位的是禁忌证、不良反应处置,排名后2位的是给药方式、适应证。共纳入100份病历,用药方案与最优方案接近程度(C_(i))≥0.8(合理)的0例;0.6≤C_(i)<0.8(基本合理)的83例(83.00%);C_(i)<0.6(不合理)的17例(17.00%)。不合理用药主要表现在超适应证用药、超给药方式用药、存在潜在药物相互作用、给药剂量不适宜、违反用药禁忌证等方面。结论基于加权TOPSIS法的贝米肝素钠注射液DUE方法可综合多个评价指标,可操作性强,评价结果客观可信。该院贝米肝素钠注射液临床应用基本合理,需加快超说明书用药循证评价流程,加强管理力度,以保证临床合理用药。

基于加权TOPSIS法评价阿替普酶治疗急性缺血性脑卒中的合理性

目的建立阿替普酶治疗急性缺血性脑卒中(AIS)药物利用评价(DUE)标准,并采用加权优劣解距离(TOPSIS)法对其使用情况进行评价,为合理使用阿替普酶提供参考。方法参照药品说明书和相关指南文献,结合专家咨询法制订阿替普酶治疗AIS的DUE标准,收集广西壮族自治区人民医院2020年1月—2022年6月使用注射用阿替普酶治疗AIS的住院患者病历,采用基于属性层次模型的加权TOPSIS法进行合理性点评。结果共纳入126份病历,用药方案与最优方案的相对接近程度(C_(i))>0.8(合理)的80例(63.49%),C_(i)介于0.6~0.8(基本合理)的40例(31.75%),C_(i)<0.6(不合理)的6例(4.76%)。不合理用药情况主要为禁忌证(32.54%)、给药剂量(7.14%)和药物转换(7.14%)等方面。结论采用加权TOPSIS法评价阿替普酶治疗AIS的合理性,结果更直观和全面,该院阿替普酶的使用存在一定问题,需要在用药禁忌证、给药剂量等方面加强干预,促进临床合理使用阿替普酶。

体重控制药物临床试验的现状分析

目的:分析中国在2018至2023年间的体重控制药物临床试验的研究现况和发展趋势,为体重控制药物临床试验研究方向提供参考。方法:检索并收集我国药物临床研究注册与信息公开平台上注册的体重控制药物临床试验的详细信息。对体重控制药物临床试验发展趋势、注册特点、作用机制及主导单位的地理位置进行了分析。结果:2023年体重控制药物临床试验注册数量达到了近年来的最高点。临床Ⅰ期、Ⅱ期和Ⅲ期临床试验占87.9%(51/58),试验设计以平行、随机化和双盲试验为主。在作用靶点方面,胰高血糖素样肽-1(Glucagon-likepeptide-1,GLP-1)受体激动剂单靶点试验数量居首(27/58)。药物临床试验主导单位主要分布在北京市(27/58)、上海市(6/58)和长沙市(5/58)。结论:体重控制药物的临床试验数量呈现出上升趋势,特别是在基于GLP-1受体激动剂的单靶点及多靶点联合治疗领域的临床试验发展尤为迅猛。

基于加权TOPSIS法的奥扎格雷钠药物利用评价

目的 基于加权优劣解距离(TOPSIS)法评价奥扎格雷钠的临床使用,为提高奥扎格雷钠合理使用提供参考依据。方法 参考奥扎格雷钠药品说明书、相关指南和文献,并通过德尔菲法,制定奥扎格雷钠药物利用评价标准,采用属性层次分析法赋予各指标权重,并通过TOPSIS法对河南省直第三人民医院2021年1月—2022年4月108例出院患者使用奥扎格雷钠的合理性进行评价。结果 两轮专家咨询的问卷回收率均为100%,权威系数(Cr)分别为0.85,0.83(> 0.70),且专家对标准各条目给予了充分肯定。纳入评价的108份病历中,37份(34.26%)判定为合理,52份(48.15%)判定为基本合理,19份(17.59%)判定为不合理。不合理用药主要表现为超适应证用药、给药时机不恰当、用药疗程不足、疗效和实验室监测不充分等方面。结论 基于加权TOPSIS法进行用药合理性评估更直观、科学。该院奥扎格雷钠的使用总体较为规范,但在用药疗程、适应证、给药时机等方面存在问题,应加强医师与药师协作,建立完善药学干预机制,促进其临床合理应用。

西藏自治区人民医院实施国家重点监控药品干预成效分析

目的:评价西藏自治区人民医院对重点监控药品进行重点干预的成效,为优化重点监控药品干预策略、促进临床合理用药提供参考。方法:西藏自治区人民医院于2020年制订《西藏自治区人民医院重点监控药品管理规定》,建立《西藏自治区人民医院重点监控药品目录》,同时开展重点监控药品处方及医嘱专项点评、采取点评结果公示及绩效考核挂钩等目标性干预措施,对比西藏自治区人民医院2019年4月-2020年3月(干预前)与2020年4月-2021年3月(干预后第一年)及2021年4月-2022年3月(干预后第二年)重点监控药品临床使用数据变化,评价重点干预措施对该类药品的管理成效及临床使用的影响。结果:该院干预后第一年及第二年的重点监控药品销售金额分别为1427.01万元、1388.12万元,低于干预前的2004.29万元;干预后重点监控药品销售金额占药品总销售金额比例分别为8.33%、7.47%,低于干预前的10.11%。重点监控药品各品种的DDC普遍较高,患者的经济负担较重。结论:西藏自治区人民医院重点监控药品的干预取得了一定成效,但医院应在此基础上采取有力措施,提高重点监控药品合理使用,进一步减轻患者经济负担。

新型口服抗凝剂治疗癌症患者静脉血栓栓塞有效性及安全性的Meta分析

目的系统评价癌症相关静脉血栓栓塞(VTE)患者使用新型口服抗凝剂(NOAC)的有效性和安全性。方法检索PubMed、Cochrane Library、Embase、Web of Science、中国知网、万方数据库,检索时限为各数据库建库起至2023年8月,收集低分子肝素(LMWH,对照组)对比NOAC(试验组)治疗癌症相关VTE患者疗效的随机对照试验(RCT),对纳入临床研究进行资料提取后,采用RevMan 5.0统计软件进行Meta分析。结果共计纳入7项RCT,合计3790例癌症相关VTE患者。与对照组相比,试验组患者的VTE复发率(RR=0.65,95%CI为0.51~0.82,P=0.0004)显著降低,而其大出血发生率略高于对照组,但差异无统计学意义(RR=1.13,95%CI为0.83~1.53,P=0.45)。试验组患者的临床相关非主要大出血(RR=1.69,95%CI为1.34~2.13,P<0.00001)、消化道出血(RR=1.96,95%CI为1.15~3.34,P=0.01)发生率均较对照组显著升高。两组患者颅内出血发生率、全因死亡率、致死性肺栓塞发生率比较,差异均无统计学意义(P>0.05)。结论对于癌症相关VTE患者,NOAC在预防VTE复发方面优于LMWH,在大出血、颅内出血、全因死亡、致死性肺栓塞方面不劣于LMWH。

阻塞性睡眠呼吸暂停综合征、肥胖、代谢综合征的病理生理联系及治疗进展

全球范围内超重和肥胖发生率持续上升,阻塞性睡眠呼吸暂停综合征(OSAS)的首要危险因素是肥胖,在全世界肥胖人口数量升高的同时,OSAS患病率也不断上调。OSAS与肥胖密切相关,肥胖通过促进气道的可塌陷性等原因导致OSAS,OSAS通过睡眠减少、食欲亢进等机制加重肥胖。肥胖极易引发代谢综合征(MS),OSAS对于MS具有促发效应,逆转肥胖可能是打破这一恶性循环的关键。对于OSAS,主要的传统疗法为无创呼吸机持续正压通气治疗,此疗法虽然可使OSAS患者睡眠时的缺氧问题及呼吸暂停症状得到改善,但并不能改善患者的代谢状态。目前,对于OSAS治疗的最新进展包括运动、饮食控制等生活方式的干预,使用一些新上市的减肥药物及中药和中医点穴,同时使用设计的唱歌训练法等方式,以及目前仍处于研究阶段的棕色脂肪、基因靶向治疗等,这些新进展的发现可能是改善OSAS合并MS及肥胖患者预后的有效手段。

肠道菌群与药物相关性骨坏死:两样本双向孟德尔随机化分析

背景:药物相关性骨坏死是一类应用药物后出现的严重不良反应。大量的证据表明,肠道菌群与药物相关性骨坏死有关。然而,肠道菌群对药物相关性骨坏死的因果关系尚不清楚。目的:采用孟德尔随机化方法来评估肠道菌群与药物相关性骨坏死风险之间的潜在因果关系。方法:使用MiBioGen联盟肠道菌群的全基因组关联分析(GWAS)汇总统计数据(n=13266)和芬兰R9数据库中药物相关性骨坏死的GWAS数据(264例药物相关性骨坏死患者和377013例健康对照者)。采用逆方差加权法、MR-Egger回归法、加权中位数法、加权模型法和简单模型法来研究肠道菌群与药物相关性骨坏死之间的因果关系。敏感性分析用于检验孟德尔随机化分析结果是否可靠。反向孟德尔随机化以全部肠道菌群作为结局进行效应分析和敏感性分析。结果与结论:①逆方差加权法结果显示,黏胶球形菌门、黏胶球形菌纲、黑色素杆菌纲、嗜胃杆菌目、红螺菌目、食物谷菌目和双歧杆菌属与药物相关性骨坏死呈直接的正向因果关联;甲烷杆菌纲、芽孢杆菌目、甲烷杆菌目、毛螺菌科、甲烷杆菌科、霍尔德曼氏菌属、毛螺菌属(UCG010)、厌氧杆菌和泰泽氏菌属与药物相关性骨坏死呈直接的负向因果关联。②反向孟德尔随机化结果显示,药物相关性骨坏死与梭菌科、消化链球菌科、链球菌科、梭状芽胞杆属和链球菌属呈直接的负向因果关联,与艾森伯格菌属呈直接的正向因果关联。③双向敏感性分析均未发现存在异质性或水平多效性。④结果证实,肠道菌群作为暴露,药物相关性骨坏死作为结局,7种细菌性状对药物相关性骨坏死呈正相关因果关系,9种细菌性状对药物相关性骨坏死呈负相关因果关系;药物相关性骨坏死作为暴露,肠道菌群作为结局,药物相关性骨坏死与5种细菌性状有负相关因果关系,与1种细菌性状有正相关因果关系。改变肠道菌群的多样性和组成,有望改善药物相关性骨坏死的发病与预后,为骨科疾病的研究提供了思路。

苦参-黄柏药对的提取工艺研究

目的研究苦参-黄柏药对的提取工艺,为治疗肛肠疾病的新药开发提供参考依据。方法以苦参总碱(苦参碱+氧化苦参碱)含量、盐酸小檗碱含量、总黄酮含量及浸膏得率为评价指标,采用层次分析法-熵权法计算各指标权重系数,结合Box-Behnken设计-响应面法研究苦参-黄柏药对的最佳提取工艺并进行验证。结果苦参-黄柏药对的最优提取工艺为以12倍量58%乙醇浸泡30 min后提取2次,每次120 min。验证实验结果与预测值的相对误差为1.88%。结论所得提取工艺稳定、可行,可为苦参-黄柏药对的进一步应用与新药开发提供参考。

应用失效模式与效应分析法提高药房盘点质量探索

目的:优化现代化门诊药房药品盘点过程以提升盘点质量。方法:通过文献检索、头脑风暴等方法绘制药品盘点流程图并收集每个子流程的潜在失效模式及失效原因,应用失效模式与效应分析法(Failure Mode and Effect Analysis,FMEA)对各失效模式发生的可能性、严重性和可侦测度进行评分及风险优先值(RPN)计算,量化并确定高风险失效模式,制定改进措施并实施,分析改善效果。结果:确定了盘点的3个主流程和12个子流程,以及各子流程相关的21项失效模式和38项失效原因,高风险因素共15项,制定针对性改进措施28项。干预改进后,各高风险失效模式RPN值均显著降低,其中最高的4项由392、288、280、280分别降至42、48、56、63,均处于相对低风险区域;干预管理前后复盘相符率由82.4%上涨至96.2%,盘存时长由180.2 min降至155.3 min。结论:FMEA法在药品盘点过程存在问题分析改进中的价值是肯定的,制定的各项改进措施,尤其是针对现代化药房自动化设备盘存模块的相关措施,以及低代码平台在智能化盘点中的应用等对于盘点质量的提升作用非常显著,值得借鉴并推广运用来提升药品经济和质量管理。

基于加权TOPSIS法的注射用比伐芦定药物利用评价

目的 建立注射用比伐芦定药物利用评价(DUE)标准,并采用加权优劣解距离(TOPSIS)法对其使用情况进行评价,为比伐芦定的合理用药提供参考依据。方法基于国内外药品说明书、权威文献,通过德尔菲法制定注射用比伐芦定的DUE标准细则。采用加权TOPSIS法对山西白求恩医院2022年1—6月使用注射用比伐芦定的出院患者病历进行合理性评价。结果 纳入108份病历,用药方案与最优方案接近程度(C_(i))≥0.8(合理)的88例(81.48%),0.6≤C_(i)<0.8(基本合理)的19例(17.59%),C_(i)<0.6(不合理)的1例(0.93%)。标准细则中各评价指标不合理问题主要表现为给药剂量不适宜(12.04%)、不良反应处置不适宜(11.11%)、超禁忌证用药(3.70%)、超适应证用药(1.85%)、疗效监护不适宜(1.85%)、药物转换不适宜(1.85%)和不良反应监护不适宜(0.93%)等。结论 采用加权TOPSIS法评价注射用比伐芦定,结果更直观和全面。评价结果显示该院注射用比伐芦定在使用过程中存在一些不合理现象,需要在用法用量、不良反应处置、适应证和禁忌证等方面进一步规范注射用比伐芦定的使用。

基于加权逼近理想解排序法的卡瑞利珠单抗用药合理性评价

目的评价某院卡瑞利珠单抗的用药合理性,为其临床合理应用提供参考。方法以注射用卡瑞利珠单抗药品说明书为基础,参考《中国临床肿瘤学会(CSCO)常见恶性肿瘤诊疗指南(2022)》《新型抗肿瘤药物临床应用指导原则(2022年版)》《中国临床肿瘤学会(CSCO)免疫检查点抑制剂相关的毒性管理指南(2021)》等,制订注射用卡瑞利珠单抗评价标准;采用加权逼近理想解排序(TOPSIS)法对皖南医学院附属太和医院2021年1月至2022年12月使用注射用卡瑞利珠单抗的116份病历进行定量合理性评价。结果116份病历中,相对接近度(Ci)最高为100.00%,最低为55.65%。Ci为100.00%的28例(24.14%),80%≤Ci<90%的8例(6.90%),70%≤Ci<80%的49例(42.24%),60%≤Ci<70%的18例(15.52%),50%≤Ci<60%的13例(11.21%)。不合理用药主要表现为存在药物相互作用(41.38%)、病程记录不完整(35.34%)、溶剂体积不适宜(23.28%)、未上报药品不良反应(14.66%)、给药顺序不适宜(13.79%)、给药剂量不适宜(12.93%)。结论该院卡瑞利珠单抗的临床应用基本合理,但仍存不合理用药现象,需规范其合理使用。

Effects of polymer molecular weight on in vitro and in vivo performance of nanoparticle drug carriers for lymphoma therapy

The clinical efficacy of chemotherapeutic drugs is hindered by their poor aqueous solubility, low bioavailability and severe side effects. In recent years, polymeric nanocarriers have been used for drug delivery to improve the efficacy of many chemotherapeutics. In this study, a series of biodegradable phenylalaninebased poly(ester amide)(Phe-PEA) with tunable molecular weights(MWs) were synthesized to systematically investigate the relationship between the polymer MW and the efficacy of the corresponding polymeric nanoparticles(NPs). The results indicated that a range of polymers with different MWs can be obtained by varying the monomer ratio or reaction time. Doxorubicin(DOX), a classic clinical lymphoma treatment strategy, was selected as a model drug. The loading capacity and stability of the higher MW polymeric NPs were superior to those of the lower MW ones. Moreover, in vitro and in vivo data revealed that high MW polymeric NPs had better anticancer efficacy against lymphoma and higher biosafety than low MW polymeric nanoparticles and DOX. Therefore, this study suggests the importance of polymer MW for drug delivery systems and provides valuable guidance for the design of enhanced polymeric drug carriers for lymphoma treatment.

胰高血糖素样肽-1减肥应用的伦理探讨

针对胰高血糖素样肽-1受体激动剂类药物在治疗肥胖方面的医学价值和潜在滥用的现实情况,深入探讨了该类药物在非糖尿病肥胖治疗中的超适应证应用及其伦理问题,包括医疗资源的合理分配、患者知情同意的重要性以及社会审美标准对医疗决策的影响。并针对上述伦理问题,提出了包括加强药物处方规范、提高公众药物知识、确保患者知情同意等建议。旨在促进胰高血糖素样肽-1受体激动剂类药物在肥胖治疗中的合理及伦理使用,保障医疗伦理和患者安全。