2015~2019年住院抑郁患者抗抑郁药物使用分析
Analysis on the use of antidepressants in inpatients with depression from 2015 to 2019
投稿时间:2021-03-02  修订日期:2021-04-13
DOI:
中文关键词:  抑郁障碍  药物  趋势
英文关键词:Depressive Disorder  Medication  Trend
基金项目:北京市医院管理中心临床医学发展专项 “扬帆 ”计划临床技术创新项目(XMLX202128)
作者单位地址
付冰冰 北京 首都医科大学附属北京安定医院,国家精神心理疾病临床医学研究中心,精神疾病诊断与治疗北京市重点实验室 北京市西城区德胜门外安康胡同5号
王雪琦 北京 首都医科大学附属北京安定医院,国家精神心理疾病临床医学研究中心,精神疾病诊断与治疗北京市重点实验室 
张玲 北京 首都医科大学附属北京安定医院,国家精神心理疾病临床医学研究中心,精神疾病诊断与治疗北京市重点实验室北京 首都医科大学人脑保护高精尖创新中心 
王刚* 北京 首都医科大学附属北京安定医院,国家精神心理疾病临床医学研究中心,精神疾病诊断与治疗北京市重点实验室
北京 首都医科大学人脑保护高精尖创新中心 
北京市西城区德胜门外安康胡同5号
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中文摘要:
      目的:调查2015~2019年抑郁障碍住院患者的抗抑郁药物使用情况,了解药物品种和治疗方案的变化,为临床治疗提供参考。方法:利用京津冀大数据平台,对2015年~2019年在首都医科大学附属北京安定医院住院、符合条件的抑郁障碍患者的相关数据进行回顾性分析,描述患者抗抑郁药物品种和用药方案的变化情况。结果:2015年至2019年符合条件的患者共6043例,抗抑郁药物使用品种方面,选择性5-羟色胺再摄取抑制剂(SSRI)类中的舍曲林处方比例由23.28%下降至20.65%(P=0.021)、西酞普兰处方比例由2.52%下降至0.97%(P<0.001)、氟西汀处方比例由4.36%下降至2.86%(P=0.031)、艾司西酞普兰处方比例呈现波动趋势(P=0.031),其他SSRI药物处方趋势无统计学差异。5-羟色胺去甲肾上腺素抑制剂(SNRI)类中的度洛西汀处方比例由9.86%增加至14.55%(P<0.001)、米那普仑处方比例由0.31%逐渐增加至1.17%(P=0.004)、文拉法辛在各年间处方趋势无统计学差异(P=0.054),处方比例增加趋势的也包括新药阿戈美拉汀(0.34%-1.49%,P=0.001)、伏硫西汀(0.21%-1.1%,P<0.001)。其他药物的使用各年份间无统计学差异。从用药方案上看,单一使用抗抑郁药由25.46%下降至22.01%(调整后OR=0.68,P<0.001)、联合使用抗抑郁药由11.81%下降至5.81%(调整后OR=0.72,P=0.01),差异有统计学意义;抗抑郁药联合心境稳定剂由1.38%增加至3.83%(调整后OR=1.66,P=0.028)、抗抑郁药联合心境稳定剂及抗精神病药物的治疗方案由5.16%增加至9.03%(调整后OR=1.61,P=0.003),差异有统计学意义;而抗抑郁药联合抗精神病药物的治疗方案在5年间不存在显著性差异(P=0.072)。 结论:近5年住院抑郁障碍患者一线抗抑郁药物品种分布、联合治疗方案有较大变化。
英文摘要:
      Objective To investigate the use of antidepressants in inpatients with depression from 2015 to 2019, and to understand the changes of drug varieties and treatment schemes, so as to provide reference for clinical treatment. Methods Using the Beijing-Tianjin-Hebei big data platform, the relevant data of eligible depressive patients hospitalized in Beijing Anding Hospital affiliated to Capital Medical University from 2015 to 2019 were retrospectively analyzed, and the changes of antidepressant drugs and medication regimens were described. Results From 2015 to 2019, a total of 6043 cases of eligible patients, antidepressant use varieties, selective serotonin reuptake inhibitors (SSRI) class of sertraline prescription from 23.28% to 20.65% (P =0.021), citalopram prescription from 2.52% to 0.97% (P<0.001), fluoxetine prescription from 4.36% to 2.86% (P=0.031), the proportion of escitalopram prescription showed a trend of fluctuations (P=0.031), There was no statistically significant difference in the prescribing trends of other SSRIs. The prescription proportion of duloxetine in serotonin norepinephrine inhibitor (SNRI) increased from 9.86% to 14.55% (P<0.001), and the prescription proportion of milnacipran gradually increased from 0.31% to 1.17%(P=0.004). Venlafaxine had no significant difference in prescription trend among different years (P=0.054). The increasing trend of prescription proportion also included the new drug agomelatine (0.34%-1.49%, P= 0.001), vortioxetine (0.21%-1.1%,P<0.05). There was no statistical difference in the use of other drugs from year to year. In terms of medication regimen, the single use of antidepressants decreased from 25.46% to 22.01% (adjusted OR=0.68,P<0.001), and the combined use of antidepressants decreased from 11.81% to 5.81% (adjusted OR=0.72,P=0.01). The difference was statistically significant. The combination of antidepressants and mood stabilizers increased from 1.38% to 3.83% (adjusted OR=1.66,P=0.028), and the treatment regimens of antidepressants combined with mood stabilizers and antipsychotics increased from 5.16% to 9.03% (adjusted OR=1.61,P=0.003). However, there was no significant difference in the treatment regimen of antidepressants combined with antipsychotics in 5 years. Conclusion The variety distribution and combined treatment regimen of first-line antidepressants in inpatients with depressive disorder have changed greatly in recent 5 years.
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