中国狼疮肾炎住院患者治疗模式的研究（英文）
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- 英文论文题名：Study on the treatment pattern of inpatients with lupus nephritis in China
- 论文作者：张乐 ; 吴斌 ; 叶霜 ; 李挺 ; 陆国红
- 英文论文作者：Lu Guohong ; Department of Pharmacy ; South Campus ; Ren Ji Hospital ; School of medicine ; Shanghai Jiaotong University
- 年：2016
- 作者机构：上海交通大学医学院附属仁济医院南院药剂科;上海交通大学医学院附属仁济医院南院风湿科;
- 论文关键词：狼疮肾炎 ; 治疗方案 ; 直接医疗成本
- 会议召开时间：2016-09-27
- 会议录名称：中国药学会第十三届青年药学科研成果交流会论文集
- 语种：英文
- 分类号：R593.242
- 学会代码：YYWS
- 会议名称：中国药学会第十三届青年药学科研成果交流会
- 会议地点：中国江西南昌
- 主办单位：中国药学会
- 学会名称：中国药学会
- 页数：17
- 文件大小：1805k
- 原文格式：O
- 会议级别：全国
摘要
目的研究狼疮肾炎在中国的治疗模式。方法:从仁-济医院病历系统数据库中提取2014年1月至2015年12月间,诊断为狼疮肾炎的住院患者的数据,包括了医嘱明细、收费明细、检验、疾病活跃度评分等项目。从患者疾病直接费用、治疗方案、风湿疾病药物利用情况、非风湿药物利用情况、治疗方案对总费用的影响等方面开展相关研究。结果:共纳入305名狼疮肾炎的患者,女性患者271名(88.85%),平均住院天数为12.60±10.71天,55.84%的患者年龄在21~40岁之间。人均直接医疗成本为$2109.26,呈对数正态分布,其中包括一般医疗服务费、护理费、诊断费、药费等,其中药费所占比例最高。在非风湿病治疗药物中,消化系统药物使用频率最高(95.03%),抗菌药物人均花费金额最高($581.76)。风湿病治疗药物中,肾上腺糖皮质激素使用频率最高(90.73%),免疫抑制剂与调节剂类药物(80.13%)其次,但它的人均花费最高($102.24)。在这些药物中,醋酸泼尼松片与硫酸羟氯喹片使用频率最高(66.89%),然后依次是注射用甲泼尼龙琥珀酸钠(甲强龙40mg)(48.34%),吗替麦考酚酯(27.15%)等。而人均花费最高的药物是他克莫司($219.6),然后依次是磷酸氯喹片($219.64),吗替麦考酚酯($164.53),注射用甲泼尼龙琥珀酸钠(甲强龙500mg)($72.13),环孢素软胶囊($70.01)等。在治疗方案中,单独使用硫酸羟氯喹片的频率最高(34.43%),其次是HCQ+MMF(20%),HCQ+CTX(7.54%),单独使用CTX(3.93%)。所有治疗方案中,风湿疾病药品花费价格最高的方案是HCQ+MMF+CTX($27 1.5),其次是HCQ+MMF($252.99),MMF+THA($229.03),MMF+CTX($222.59)等。在这些方案中,使用MMF+THA的患者,最终直接医疗成本最高,为$4031.61,其次是使用THA的患者($4031.61),THA($3916.91),HCQ+MMF+CTX($2960.57),MMF+CTX($2921.20)等。直接医疗成本最低的治疗方案是HCQ+CTX+THA($912.93),其次是HCQ+MMF+THA($l 137.78),CTX+THA($1496.58),单独使用MMF($1727.75),HCQ+MMF($1931.88)。结论:这项研究证明,药物费用占直接医疗成本比例最大,在选择药物治疗狼疮性肾炎患者时应考虑其理论基础和成本选择。
引文
1 Dooley MA,Aranow C,Ginzler EM.Review of ACR renal criteria in systemic lupus erythematosus.Lupus 2004;13:857-860.
2 KasitanonN,MagderLS,Petri M.Predictors of survival in systemic lupus erythematosus.Medicine(Baltimore)2006;85:147-156.
3 Tikly M,Navarra SV.Lupus in the developing world-is it any different?Best Pract Res ClinRheumatol2008;22(4):643-655.
4 Alarcon GS,McGwin G Jr,Petri M,Reveille JD,Ramsey-Goldman R,Kimberly RP.Baseline characteristics of a multiethnic lupus cohort:PROFILE.Lupus 2002;11:95-101.
5 Hans-Joachim Andersl,Marc Weidenbuschl,and Brad Rovin.Unmet medical needs in lupus nephritis:solutions through evidence-based,personalized medicine.Clinical Kidney Journal2015;8(5):492-502.
6Dooley MA,Houssiau F,Aranow C et al.Effect of belimumab treatment on renal outcomes:results from the phase 3 belimumab clinical trials in patients with SLE.Lupus 2013;22:63-72.
7 Navarra SV,Guzman RM,Gallacher AE et al.Efficacy and safety of belimumab in patients with active systemic lupus erythematosus:a randomised,placebo-controlled,phase 3 trial.Lancet 2011;377:721-731.
8 BEVRA H.HAHN,MAUREEN A.MCMAHON,ALAN WILKTNSON.et al.American College of Rheumatology Guidelines for Screening,Treatment,and Management of Lupus Nephritis.Arthritis Care&Research 2012;64(6):797-808.
9 Canadian Hydroxychloroquine Study Group.A randomized study of the effect of withdrawing hydroxychloroquine sulfate in systemic lupus erythematosus.N Engl J Med 1991;324:150-154.
10 Fessler BJ,Alarcon GS,McGwin G Jr,Roseman J,Bastian HM,Friedman AW,et al,for the LUMINA Study Group.Systemic lupus erythematosus in three ethnic groups.XVI.Association of hydroxychloroquine use with reduced risk of damage accrual.Arthritis Rheum2005;52:1473-1480.
11 Pons-Estel GJ,Alarcon GS,McGwin G Jr,Danila MI,Zhang J,Bastian HM,et al,for the LUMINA Study Group.Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis:LXV,data from a multiethnic US cohort.Arthritis Rheum2009;61:830-839.
12 Jung H,Bobba R,Su J,Shariati-Sarabi Z,Gladman DD,Urowitz M,et al.The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus.Arthritis Rheum 2010;62:863-868.
13 Candace H.Feldman,Linda T.Hiraki,Wolfgang C.Winkelmighter,et al.Serious Infections among Adult Medicaid Beneficiaries with Systemic Lupus Erythematosus and Lupus Nephritis.Arthritis Rheumatol 2015;67(6):1577-1585.
14 Fredeiic A Houssiau.Therapy of lupus nephritis:lessons learned from clinical research and daily care of patients.Arthritis Res Ther 2012;14(1):202.
15 Jones RB,Walsh M,Smith KG.What is the value of mycophenolate mofetil as induction and maintenance therapy in lupus nephritis?CurrOpinRheumatol 2009;21(3):256-261.
16 Confreres G,Tozman E,Nahar N,Metz D.Maintenance therapies for proliferative lupus nephritis:mycophenolate mofetil,azathioprine and intravenous cyclophosphamide.i,w/?M.s 2005;14 Suppl l:s33-38.
17 Jing Huang,Sha-sha Han,Dan-dan Qin,et al.Renal Interstitial Arteriosclerotic Lesions in Lupus Nephritis Patients:A Cohort Study from China.PLOS ONE 2016;6:1-15.
18 Gomez-Puerta JA,Barbhaiya M,Guan H,et al.Racial/Ethnic variation in all-cause mortality among United States medicaid recipients with systemic lupus erythematosus:a Hispanic and asian paradox.Arthritis Rheumatol 20\5;67(3):752-760.
2 KasitanonN,MagderLS,Petri M.Predictors of survival in systemic lupus erythematosus.Medicine(Baltimore)2006;85:147-156.
3 Tikly M,Navarra SV.Lupus in the developing world-is it any different?Best Pract Res ClinRheumatol2008;22(4):643-655.
4 Alarcon GS,McGwin G Jr,Petri M,Reveille JD,Ramsey-Goldman R,Kimberly RP.Baseline characteristics of a multiethnic lupus cohort:PROFILE.Lupus 2002;11:95-101.
5 Hans-Joachim Andersl,Marc Weidenbuschl,and Brad Rovin.Unmet medical needs in lupus nephritis:solutions through evidence-based,personalized medicine.Clinical Kidney Journal2015;8(5):492-502.
6Dooley MA,Houssiau F,Aranow C et al.Effect of belimumab treatment on renal outcomes:results from the phase 3 belimumab clinical trials in patients with SLE.Lupus 2013;22:63-72.
7 Navarra SV,Guzman RM,Gallacher AE et al.Efficacy and safety of belimumab in patients with active systemic lupus erythematosus:a randomised,placebo-controlled,phase 3 trial.Lancet 2011;377:721-731.
8 BEVRA H.HAHN,MAUREEN A.MCMAHON,ALAN WILKTNSON.et al.American College of Rheumatology Guidelines for Screening,Treatment,and Management of Lupus Nephritis.Arthritis Care&Research 2012;64(6):797-808.
9 Canadian Hydroxychloroquine Study Group.A randomized study of the effect of withdrawing hydroxychloroquine sulfate in systemic lupus erythematosus.N Engl J Med 1991;324:150-154.
10 Fessler BJ,Alarcon GS,McGwin G Jr,Roseman J,Bastian HM,Friedman AW,et al,for the LUMINA Study Group.Systemic lupus erythematosus in three ethnic groups.XVI.Association of hydroxychloroquine use with reduced risk of damage accrual.Arthritis Rheum2005;52:1473-1480.
11 Pons-Estel GJ,Alarcon GS,McGwin G Jr,Danila MI,Zhang J,Bastian HM,et al,for the LUMINA Study Group.Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis:LXV,data from a multiethnic US cohort.Arthritis Rheum2009;61:830-839.
12 Jung H,Bobba R,Su J,Shariati-Sarabi Z,Gladman DD,Urowitz M,et al.The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus.Arthritis Rheum 2010;62:863-868.
13 Candace H.Feldman,Linda T.Hiraki,Wolfgang C.Winkelmighter,et al.Serious Infections among Adult Medicaid Beneficiaries with Systemic Lupus Erythematosus and Lupus Nephritis.Arthritis Rheumatol 2015;67(6):1577-1585.
14 Fredeiic A Houssiau.Therapy of lupus nephritis:lessons learned from clinical research and daily care of patients.Arthritis Res Ther 2012;14(1):202.
15 Jones RB,Walsh M,Smith KG.What is the value of mycophenolate mofetil as induction and maintenance therapy in lupus nephritis?CurrOpinRheumatol 2009;21(3):256-261.
16 Confreres G,Tozman E,Nahar N,Metz D.Maintenance therapies for proliferative lupus nephritis:mycophenolate mofetil,azathioprine and intravenous cyclophosphamide.i,w/?M.s 2005;14 Suppl l:s33-38.
17 Jing Huang,Sha-sha Han,Dan-dan Qin,et al.Renal Interstitial Arteriosclerotic Lesions in Lupus Nephritis Patients:A Cohort Study from China.PLOS ONE 2016;6:1-15.
18 Gomez-Puerta JA,Barbhaiya M,Guan H,et al.Racial/Ethnic variation in all-cause mortality among United States medicaid recipients with systemic lupus erythematosus:a Hispanic and asian paradox.Arthritis Rheumatol 20\5;67(3):752-760.