老年患者长期用药的潜在药物相互作用及其影响因素分析

刘悦; 龚辉; 单青; 李晨; 李树; 陈孟莉

doi:10.3969/j.issn.2095-5227.2023.06.003

老年患者长期用药的潜在药物相互作用及其影响因素分析

Potential drug-drug interactions and its associated factors in long-term drug use in elderly patients

摘要

摘要:
背景药物-药物相互作用(drug-drug interactions， DDIs)是导致药物不良反应的因素，识别和避免DDIs对于优化老年患者药物治疗效果十分必要。
目的分析老年患者长期用药中潜在的具有临床意义的DDIs发生情况及相关影响因素，为老年药物合理使用提供依据。
方法 2018年12月 - 2020年3月、2021年5月 - 2022年4月，在北京三个社区≥65岁的老年人群中开展横断面研究，使用《老年人潜在的具有临床意义的DDIs国际共识清单》评估患者长期用药中的DDIs发生情况，通过logistic回归分析DDIs的危险因素。
结果共纳入老年患者683例，年龄Md(IQR)：84(79 ~ 88)岁，至少发生1种潜在DDIs的患者202例(29.6%)。其中药品使用的种类越多，发生潜在DDIs的概率越高(与2 ~ 4种相比：5 ~ 9种，OR=2.751，95% CI：1.627 ~ 4.652，P＜0.001；10 ~ 14种，OR=5.006，95% CI：2.813 ~ 8.907，P＜0.001；≥15种，OR=11.27，95% CI：5.140 ~ 24.711，P＜0.001)，衰弱状态(OR=1.757，95% CI：1.184 ~ 2.606，P=0.005)、有潜在不适当用药(OR=2.722，95% CI：1.863 ~ 3.976，P＜0.001)、有心血管疾病(OR=6.759，95% CI：1.549 ~ 29.501，P=0.011)者发生潜在DDIs的概率更高。最常见的潜在DDIs为同时使用两种以上保钾药，所有与非甾体抗炎药有关的药物相互作用中，患者均使用了阿司匹林。
结论社区老年人用药中潜在的具有临床意义的DDIs多见，应特别关注多药、衰弱、具有心血管疾病、有潜在不适当用药的老年患者DDIs发生情况，加强潜在DDIs的相关风险监测，以优化药物治疗效果，减少不良结局。

Abstract:
Background Drug-drug interactions (DDIs) are one of the factors for adverse drug reactions. It is necessary to identify and avoid DDIs to optimize the efficacy of drug therapy in elderly patients.
Objective To study the prevalence of potentially clinically significant DDIs and related influencing factors in elderly patients in the communities, and provide evidence for rational drug use in the elderly.
Methods A cross-sectional study was conducted from December 2018 to April 2022 in a cohort of older adults ≥65 years old in three communities in Beijing. The occurrence of potential DDIs in patients' long-term medication use was assessed using the International Consensus List of Potentially Clinically Significant DDIs in Older People, and risk factors for potential DDIs were analyzed by Logistic regression.
Results A total of 683 elderly patients with a median age (interquartile spacing) of 84 (79 - 88) years were included, and 202 (29.6%) patients had at least one potential DDIs. The more the number of drugs used, the higher the probability of potential DDIs (compared with 2-4: 5-9, OR=2.751, 95%CI: 1.627-4.652, P<0.001; 10-14, OR=5.006, 95% CI: 2.813-8.907, P<0.001; ≥15, OR=11.27, 95% CI: 5.140-24.711, P<0.001). Patients in frail status (OR=1.757, 95% CI: 1.184-2.606, P=0.005), with PIM (OR=2.722, 95% CI: 1.863-3.976, P<0.001), and cardiovascular disease (OR=6.759, 95% CI: 1.549-29.501, P=0.011) had a higher risk of potential DDIs. The most common potential DDIs were the concomitant use of more than two potassium-preserving drugs, and aspirin was used by patients in all potential DDIs related to NSAIDs.
Conclusion Potentially clinically significant DDIs are common in elderly patients in the community. Special attention should be paid to the occurrence of DDIs in elderly patients with polypharmacy, frailty, cardiovascular disease, and PIM, and to enhancing the monitoring of risks associated with potential DDIs to optimize pharmacotherapy outcomes and reduce adverse outcomes.

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