摘要
目的为糖尿病肾病(DN)患者降糖药临床合理应用提供参考。方法利用医院电子病历系统检索某三级甲等医院2023年1月至8月按医嘱出院患者的病历资料,提取患者的基本资料、实验室指标及医嘱用药(2010 d)情况,根据预估肾小球滤过率(eGFR)评估用药情况,记录患者住院期间降糖药使用情况,并基于Apriori算法分析患者降糖药联合应用的关联性。结果纳入患者197例,其中男135例、女62例,年龄(59.82±13.75)岁,体质量指数(25.09±3.26)kg/m^(2),超重/肥胖患者124例(62.94%),合并心血管疾病(高血压)140例(71.06%);共使用降糖药8类、31个品种。胰岛素类在不同eGFR分期患者中使用率均较高(≥77.78%),随着eGFR的增大,患者降糖药使用种数逐渐增多(10→31种),钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)类、双胍类使用率逐渐增加。最常发生的二联用药为胰岛素类+SGLT2i类(支持度57.26%,置信度79.76%),三联用药为SGLT2i类+胰岛素类+胰高血糖素样肽-1受体激动剂(GLP-1RAs)类(支持度26.63%,置信度76.84%),SGLT2i类、胰岛素类、GLP-1RAs类关联性较强。13例(6.54%)患者未根据eGFR水平进行药物减量或禁用,涉及药物分别为二甲双胍片、西格列汀片、沙格列汀片、利拉鲁肽注射液等。结论该院DN患者较多合并心血管疾病患者,降糖治疗以联合用药为主,SGLT2i类因可使患者心肾获益及减轻体质量已成为联合用药的最广泛选择,与临床诊疗指南推荐基本相符。同时建议临床根据eGFR水平针对性调整降糖药剂量,加强合理用药管理。
Objective To provide reference for clinical rational application of hypoglycemic drugs in patients with diabetic nephropathy(DN).Methods The hospital electronic medical record system was used to retrieve the medical records of DN patients discharged from a tertiary hospital from January to August 2023 according to the medical orders.The patient's basic data,laboratory indicators and medication according to medical orders(2010 d)were extracted.The medication was evaluated according to the estimated glomerular filtration rate(eGFR),and the use of hypoglycemic drugs during hospitalization was recorded.Based on the Apriori algorithm,the correlation between the combined application of hypoglycemic drugs was analyzed.Results A total of 197 patients were included,among which 135 cases were males and 62 cases were females,the age was(59.82±13.75)years,the body mass index was(25.09±3.26)kg/m^(2),there were 124 cases(62.94%)with overweight/obesity,and 140 cases(71.06%)with cardiovascular disease(hypertension).A total of 8 categories and 31 varieties of hypoglycemic drugs were used.The usage rate of insulin in patients with different eGFR was higher(≥77.78%).With the increase of eGFR,the number of hypoglycemic drugs used by patients gradually increased(10→31 varieties),and the usage rate of sodium-glucose cotransporter 2(SGLT2i)and biguanides gradually increased.The most common dual therapy was insulin+SGLT2i(support was 57.26%,confidence was 79.76%),and the triple therapy was SGLT2i+insulin+glucagon-like peptide-1 receptor agonists(GLP-1 RAs)(support was 26.63%,confidence was 76.84%).SGLT2i,insulin and GLP-1 RAs were strongly correlated.A total of 13 cases(6.54%)did not reduce or discontinue medications according to their eGFR levels.The involved drugs included Metformin Tablets,Sitagliptin Tablets,Saxagliptin Tablets,Liraglutide Injection,etc.Conclusion A large number of DN patients in this hospital are complicated with cardiovascular diseases,and hypoglycemic therapy is mainly based on combination medication.SGLT2i has become the most widely used choice in combination therapy due to their ability to bring cardiorenal benefits and reduce body weight in patients,which is basically consistent with the recommendations in clinical practice guidelines.Meanwhile,it is suggested that the dose of hypoglycemic drugs should be adjusted according to the level of eGFR,and strengthen the management of rational drug use.
作者
雷婷
程云生
于刚
贾犇黎
王媛媛
LEI Ting;CHENG Yunsheng;YU Gang;JIA Benli;WANG Yuanyuan(The Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui,China 230601)
出处
《中国药业》
2025年第18期15-19,共5页
China Pharmaceuticals
基金
安徽省卫生健康科研项目[AHWJ2023BAc10009]。
关键词
APRIORI算法
糖尿病肾病
降糖药
关联分析
Apriori algorithm
diabetic nephropathy
hypoglycemic drugs
Correlation analysis
