浙江省11家医院2013-2017年抗抑郁药使用分析
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摘要
目的:了解浙江省抗抑郁药的使用情况,为促进临床合理用药提供参考。方法:采用世界卫生组织推荐的限定日剂量(DDD)分析法,对浙江省11家医院2013-2017年抗抑郁药的销售金额、主要品种、用药频度(DDDs)和日均费用(DDC)及排序比(B/A值,即为某药品销售金额排序/某药品DDDs排序,该值<1说明药品价格较高,反之说明药品价格较低)等进行统计分析。结果:浙江省11家医院2013-2017年抗抑郁药销售金额逐年上升,由2013年的323.52万元上升至2017年的456.91万元,但抗抑郁药占所有药物销售金额的比例较稳定,约在0.47%～0.50%之间;氟西汀、度洛西汀、奥氮平以及文拉法辛的销售金额较高,占比维持在前5位,艾司西酞普兰的销售金额占比涨幅较大(占比由2013年的第8位上升至2017年的第1位);5年内,氟西汀、帕罗西汀以及舍曲林的DDDs基本均位列前3,奥氮平、喹硫平以及度洛西汀的DDC位列前3;总体上B/A值<1的药物包括度洛西汀、奥氮平、文拉法辛以及喹硫平等,B/A值>1的药物有帕罗西汀和舍曲林。结论:浙江省11家医院抗抑郁药的临床使用结构较为合理,选择性5-羟色胺(5-HT)再摄取抑制剂和选择性5-HT和去甲肾上腺素(NE)再摄取抑制剂两类药物占据主导地位;新型抗抑郁药艾司西酞普兰体现出较好的临床前景。
OBJECTIVE:To investigate the application of antidepressants in Zhejiang province and to provide reference for rational drug use in clinic. METHODS:WHO-recommended defined daily dose(DDD)method was used to statistically analyze consumption sum,main types,defined daily dose system(DDDs),daily drug cost(DDC) and ranking ratio(B/A value,i.e.consumption sum rank/DDDs rank,B/A<1 means the price of drugs was higher,whereas the price of drugs was lower) of antidepressant drugs in 11 hospitals from Zhejiang province during 2013-2017. RESULTS:The consumption sum of antidepressants was increased year by year in 11 hospitals from Zhejiang during 2013-2017,and increased from 3 235 200 yuan in 2013 to 4 569 100 yuan in 2017;the proportion of consumption sum of antidepressants in total consumption sum of all drugs kept stable,ranging from 0.47% to 0.50%. The top 5 drugs by consumption sum were fluoxetine, duloxetine, olanzapine and venlafaxine;consumption sum of escitalopram accounted for a larger increase(proportion ration increased from 8 th place in 2013 to first place in 2017). Within 5 years,DDDs of fluoxetine,paroxetine and sertraline took up the first 3 place;DDC of olanzapine,quetiapine and duloxetine took up the first 3 place;the drugs with B/A value<1 included duloxetine,olanzapine,venlafaxine and quetiapine,etc;the drugs with B/A value>1 were paroxetine and sertraline. CONCLUSIONS:The use of antidepressant drugs in 11 hospitals from Zhejiang province is rational in structure;selective 5-hydroxytryptamine(5-HT)reuptake inhibitors(SSRI),selective 5-HT and noradrenaline reuptake inhibitor(SNRI) take up the predominant place. New antidepressant drug escitalopram shows a good clinical prospect.
OBJECTIVE:To investigate the application of antidepressants in Zhejiang province and to provide reference for rational drug use in clinic. METHODS:WHO-recommended defined daily dose(DDD)method was used to statistically analyze consumption sum,main types,defined daily dose system(DDDs),daily drug cost(DDC) and ranking ratio(B/A value,i.e.consumption sum rank/DDDs rank,B/A<1 means the price of drugs was higher,whereas the price of drugs was lower) of antidepressant drugs in 11 hospitals from Zhejiang province during 2013-2017. RESULTS:The consumption sum of antidepressants was increased year by year in 11 hospitals from Zhejiang during 2013-2017,and increased from 3 235 200 yuan in 2013 to 4 569 100 yuan in 2017;the proportion of consumption sum of antidepressants in total consumption sum of all drugs kept stable,ranging from 0.47% to 0.50%. The top 5 drugs by consumption sum were fluoxetine, duloxetine, olanzapine and venlafaxine;consumption sum of escitalopram accounted for a larger increase(proportion ration increased from 8 th place in 2013 to first place in 2017). Within 5 years,DDDs of fluoxetine,paroxetine and sertraline took up the first 3 place;DDC of olanzapine,quetiapine and duloxetine took up the first 3 place;the drugs with B/A value<1 included duloxetine,olanzapine,venlafaxine and quetiapine,etc;the drugs with B/A value>1 were paroxetine and sertraline. CONCLUSIONS:The use of antidepressant drugs in 11 hospitals from Zhejiang province is rational in structure;selective 5-hydroxytryptamine(5-HT)reuptake inhibitors(SSRI),selective 5-HT and noradrenaline reuptake inhibitor(SNRI) take up the predominant place. New antidepressant drug escitalopram shows a good clinical prospect.
引文
[1]王真真,张有志,宫泽辉.抑郁症治疗的新靶点和新策略[J].中国药理学与毒理学杂志,2010,24(5):364-370.
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[3]QIAO J,QIU J,LI DK.Gene expression analysis of multiple brain regions in major depressive disorder[J].Chin Sci Bull,2015,60(11):1010-1021.
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[9]郑学宝,王洪飞,吴新君.草酸艾司西酞普兰联合奥氮平治疗老年抑郁症的临床疗效及安全性研究[J].中国临床药理学杂志,2015,31(7):495-497.
[10]朱列和,陈树丹,陈晓莹.氟西汀联合奥氮平治疗伴自杀意念的抑郁症患者的效果[J].广东医学,2016,37(4):611-612.
[11]陈静,陆峥,李冰.喹硫平辅助治疗抑郁症的临床疗效及安全性研究[J].上海精神医学,2007,19(1):31-34.
[12]王新法,吴焕,娄涛.帕罗西汀合用喹硫平治疗双重抑郁症的随机开放试验[J].中国心理卫生杂志,2011,25(3):196-199.
[13]陈川柏.帕罗西汀联合小剂量非典型抗精神病药物对老年抑郁症的临床疗效[J].中国老年学杂志,2013,33(13):3216-3217.
[14]姜红,韩迎.抗抑郁药物新进展[J].中国药房,2004,15(5):308-310.
[15]吴斌,刘慧.南京地区34家医院2011-2014年抗抑郁药使用分析[J].中国药房,2016,27(17):2326-2328.
[16]荆绮,王明卫,倪慧艳.我中心2011-2013年抗抑郁药应用分析[J].中国药房,2015,26(11):1477-1479.
[17]杜燕京,梁晓丽,穆林.2008-2010年卫生部北京医院抗抑郁药应用分析[J].中国医院用药评价与分析,2012,12(4):305-308.
[18]FOURNIER JC,DERUBEIS RJ,HOLLON SD.Antidepressant drug effects and depression severity:a patient-level meta-analysis[J].JAMA,2010,303(1):47-53.
[19]黄好武,孟倩,周春仲.珠海市人民医院抗抑郁药应用分析[J].中国医院用药评价与分析,2016,16(5):655-657.
[20]展冠军,邵华,厉伟兰.南京某医院2008-2012年抗抑郁药的用药情况分析[J].中国全科医学,2013,16(6A):1914-1917.
[2]KESSLER RC,BERGLUND P,DEMLER O.Lifetime prevalence and age-of-onset distributions of DSM-Ⅳdisorders in the National Comorbidity Survey Replication[J].Arch Gen Psychiatry,2005,62(6):593-602.
[3]QIAO J,QIU J,LI DK.Gene expression analysis of multiple brain regions in major depressive disorder[J].Chin Sci Bull,2015,60(11):1010-1021.
[4]陈新谦,金有豫,汤光.新编药物学[M].17版.北京:人民卫生出版社,2011:245-302.
[5]THAPAR A,COLLISHAW S,PINE DS.Depression in adolescence[J].Lancet,2012,379(9820):1056-1067.
[6]SHELTON RC,TOLLEFSON GD,TOHEN M.A novel augmentation strategy for treating resistant major depression[J].Am J Psychiatry,2001,158(1):131-134.
[7]翟西菊,李瑞卿.奥氮平治疗肿瘤相关性抑郁与焦虑的效果分析[J].临床肿瘤学杂志,2014,19(5):435-438.
[8]方建忠,梅其一,杨小男.非典型抗精神病药对难治性抑郁症的治疗作用[J].临床精神医学杂志,2007,17(1):36-37.
[9]郑学宝,王洪飞,吴新君.草酸艾司西酞普兰联合奥氮平治疗老年抑郁症的临床疗效及安全性研究[J].中国临床药理学杂志,2015,31(7):495-497.
[10]朱列和,陈树丹,陈晓莹.氟西汀联合奥氮平治疗伴自杀意念的抑郁症患者的效果[J].广东医学,2016,37(4):611-612.
[11]陈静,陆峥,李冰.喹硫平辅助治疗抑郁症的临床疗效及安全性研究[J].上海精神医学,2007,19(1):31-34.
[12]王新法,吴焕,娄涛.帕罗西汀合用喹硫平治疗双重抑郁症的随机开放试验[J].中国心理卫生杂志,2011,25(3):196-199.
[13]陈川柏.帕罗西汀联合小剂量非典型抗精神病药物对老年抑郁症的临床疗效[J].中国老年学杂志,2013,33(13):3216-3217.
[14]姜红,韩迎.抗抑郁药物新进展[J].中国药房,2004,15(5):308-310.
[15]吴斌,刘慧.南京地区34家医院2011-2014年抗抑郁药使用分析[J].中国药房,2016,27(17):2326-2328.
[16]荆绮,王明卫,倪慧艳.我中心2011-2013年抗抑郁药应用分析[J].中国药房,2015,26(11):1477-1479.
[17]杜燕京,梁晓丽,穆林.2008-2010年卫生部北京医院抗抑郁药应用分析[J].中国医院用药评价与分析,2012,12(4):305-308.
[18]FOURNIER JC,DERUBEIS RJ,HOLLON SD.Antidepressant drug effects and depression severity:a patient-level meta-analysis[J].JAMA,2010,303(1):47-53.
[19]黄好武,孟倩,周春仲.珠海市人民医院抗抑郁药应用分析[J].中国医院用药评价与分析,2016,16(5):655-657.
[20]展冠军,邵华,厉伟兰.南京某医院2008-2012年抗抑郁药的用药情况分析[J].中国全科医学,2013,16(6A):1914-1917.