基于监测数据的药物不良反应快速识别及R语言实现

doi:10.3785/j.issn.1008-9292.2020.03.07

浙江大学学报（医学版）

2020, Vol. 49

Issue (2): 253-259 DOI: 10.3785/j.issn.1008-9292.2020.03.07

原著

基于监测数据的药物不良反应快速识别及R语言实现

洪东升^1,²(

),倪剑^2,³,单文雅^1,²,李璐^1,²,胡希^1,²,羊红玉^1,²,赵青威^2,*(

),张幸国^1,*(

)

1. 浙江大学医学院附属第一医院药学部, 浙江杭州 310003
2. 浙江省药物临床研究与评价技术重点实验室, 浙江杭州 310003
3. 浙江大学医学院附属第一医院信息中心, 浙江杭州 310003

Establishment of a rapid identification of adverse drug reaction program in R language implementation based on monitoring data

HONG Dongsheng^1,²(

),NI Jian^2,³,SHAN Wenya^1,²,LI Lu^1,²,HU Xi^1,²,YANG Hongyu^1,²,ZHAO Qingwei^2,*(

),ZHANG Xingguo^1,*(

)

1. Department of Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2. Key Laboratory for Drug Evaluation and Clinical Research of Zhejiang Province, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
3. Information Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China

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摘要：

目的: 构建药物不良反应信号快速识别（RiADP）模型，为临床用药的风险管理和科学决策提供帮助。方法: 在不相称性测定分析理论的基础上，结合频数法和贝叶斯法建立一种R语言环境下临床可用的RiADP模型，并通过国际医学用语词典（MedDRA）编码，实现模型参数的临床解读。以美国食品药品监督管理局实际监测数据为依据，利用建立的RiADP模型对拟用于2019冠状病毒病治疗的抗病毒药物洛匹那韦/利托那韦的肝毒性进行识别，从而对模型进行验证。结果: 本研究提出的RiADP模型包括4个模型参数：药物不良反应信号信息标准值、经验贝叶斯几何均值、报告比值比和不良反应报告例数。通过R语言参数包“PhViD”可以实现模型参数的快速输出，MedDRA编码后可转化为临床术语，形成药物不良反应的临床解释报告。模型对洛匹那韦/利托那韦肝毒性的评估结果与最新研究报道匹配，证明模型结果可靠。结论: 本研究在R语言环境下提出了一种基于上市后药物监测数据的不良反应信号快速识别方法，可以在突发公共卫生事件下实现目标药物不良反应的快速预警，为临床用药的风险管理和决策提供循证依据。

关键词： 2019冠状病毒病; 严重急性呼吸综合征冠状病毒2; 新型冠状病毒肺炎; 不良反应监测; 药物评价; R语言

Abstract:

Objective: To establish a clinically applicable model of rapid identification of adverse drug reaction program (RiADP) for risk management and decision-making of clinical drug use. Methods: Based on the theory of disproportion analysis, frequency method and Bayes method, a clinically applicable RiADP model in R language background was established, and the parameters of the model were interpreted by MedDRA coding. Based on the actual monitoring data of FDA, the model was validated by the assessing hepatotoxicity of lopinavir/ritonavir (LPV/r). Results: The established RiADP model included four parameters: standard value of adverse drug reaction signal information, empirical Bayesian geometric mean value, ratio of reporting ratio and number of adverse drug reaction cases. Through the application of R language parameter package "phViD", the model parameters could be output quickly. After being encoded by MedDRA, it was converted into clinical terms to form a clinical interpretation report of adverse drug reactions. In addition, the evaluation results of LPV/r hepatotoxicity by the model were matched with the results reported in latest literature, which also proved the reliability of the model results. Conclusion: In this study, a rapid identification method of adverse reactions based on post marketing drug monitoring data was established in R language environment, which is capable of sending rapid warning of adverse reactions of target drugs in public health emergencies, and providing intuitive evidence for risk management and decision-making of clinical drugs.

Key words: Coronavirus disease 2019 Severe acute respiratory syndrome coronavirus 2 Novel coronavirus pneumonia Adverse reaction monitoring Drug evaluation R language

收稿日期: 2020-03-06 出版日期: 2020-03-14

R969.3

基金资助: 浙江省自然科学基金(LQ20G030025);浙江省重点研发计划(2019C04006);浙江省医药卫生科技计划(2012-KY1-001-005)

通讯作者: 赵青威,张幸国 E-mail: hdswell@zju.edu.cn;qwzhao@zju.edu.cn;1182008@zju.edu.cn

作者简介: 洪东升(1985-), 男, 博士研究生, 主管药师, 主要从事合理用药及药学信息化研究; E-mail:hdswell@zju.edu.cn; https://orcid.org/0000-0003-2695-6353

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引用本文:

洪东升,倪剑,单文雅,李璐,胡希,羊红玉,赵青威,张幸国. 基于监测数据的药物不良反应快速识别及R语言实现[J]. 浙江大学学报（医学版）, 2020, 49(2): 253-259.

HONG Dongsheng,NI Jian,SHAN Wenya,LI Lu,HU Xi,YANG Hongyu,ZHAO Qingwei,ZHANG Xingguo. Establishment of a rapid identification of adverse drug reaction program in R language implementation based on monitoring data. J Zhejiang Univ (Med Sci), 2020, 49(2): 253-259.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.03.07 或 http://www.zjujournals.com/med/CN/Y2020/V49/I2/253

图 1 RiADP模型数据分析流程

表 1 美国FDA关于洛匹那韦/利托那韦引起肝功能异常信号的监测数据

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