药学服务在血脂异常患者中效果的系统评价和Meta分析

Effectiveness of Pharmacy Services in Patients with Dyslipidemia: A Systematic Evaluation and Meta-Analysis

摘要: 目的：系统评价药学服务是否能对高血脂患者的各血脂项目指标、用药不良反应发生率及用药不合理现象发生情况有所改善。方法：运用计算机检索数据库，包括CNKI、万方数据库、维普数据库、CBM、PubMed、Medline、Embase、Cochrane Library等。检索药学服务对血脂异常患者用药影响相关的随机对照试验和非随机干预性研究，限制时间为1995年1月1日~2023年12月30日。筛选文献，对纳入的研究进行资料提取，并利用相关量表进行文献质量评价，使用RevMan 5.4软件对患者血脂项目、用药不良反应发生率、用药不合理现象发生情况等进行系统评价和Meta分析。结果：共纳入24项研究，Meta分析结果显示，药学服务组HDL-C、LDL-C、TC、TG、不良反应发生率均较常规治疗组有明显改善，且均具有统计学意义(HDL-C：MD = 0.15，95% CI为0.05~0.26，P = 0.004；LDL-C：MD = −0.50，95% CI为−0.68~−0.32，P < 0.00001；TC：MD = −0.76，95% CI为−0.90~−0.62，P < 0.00001；TG：MD = −0.50，95% CI为−0.66~−0.33，P < 0.00001；不良反应发生率：RR = 0.24，95% CI为0.18~0.32，P < 0.00001)。控制用药不合理方面，从四个方面进行了分析，结果显示药学干预组均显著地优于对照组(用药重复：RR = 0.45，95% CI为0.4~0.52，P < 0.00001；用法不合：RR = 0.38，95% CI为0.32~0.46，P < 0.00001；用量不合理：RR = 0.48，95% CI为0.39~0.57，P < 0.00001；用药途径不合理：RR = 0.39，95% CI为0.33~0.47，P < 0.00001)。结论：药学服务在血脂异常患者中具有较好的应用效果，能够有效地改善血脂指标和用药情况，降低不良反应发生率，提高患者的用药安全性和合理性。

Abstract: Objective: To systematically evaluate whether pharmacy services can improve the indicators of each lipid program, the incidence of adverse drug reactions and the occurrence of irrationality in medication use in patients with hyperlipidemia. Methods: To search the database by compute, including CNKI, Wanfang and VIP database, CBM, PubMed, Medline, Embase, and Cochrane Library, etc. Randomized controlled trial and non-randomized studies of interventions related to the effect of pharmacy service interventions on medication use in patients with dyslipidemia were searched, with a restricted time period from January 1, 1995 to December 30, 2023. Literature was screened, data were extracted from the included studies, and the quality of literature was evaluated using relevant scales, and systematic evaluation and Meta-analysis of patients’ lipid programs, incidence of adverse drug reactions, and incidence of irrationality in drug use were performed using RevMan 5.4 software. Results: A total of 24 studies were included, and the results of the Meta-analysis showed that the rates of HDLC, LDLC, TC, TG, and adverse reactions in the pharmacy service intervention group were significantly improved compared with those in the conventional treatment group, and all of them were statistically significant (HDL-C: MD = 0.15, 95% CI was 0.05 to 0.26, P = 0.004; LDL-C: MD = −0.50, 95% CI was −0.68 to −0.32, P < 0.00001; TC: MD = −0.76, 95% CI was −0.90 to −0.62, P < 0.00001; TG: MD = −0.50, 95% CI was −0.66 to −0.33, P < 0.00001; incidence of adverse reactions: RR = 0.24, 95% CI was 0.18 to 0.32, P < 0.00001). In terms of controlling medication irrationality, four aspects were analyzed, and the results showed that the pharmacy intervention group was significantly better than the control group (Duplication of medication: RR = 0.45, 95% CI 0.4 to 0.52, P < 0.00001; Irrational dosage: RR = 0.38, 95% CI 0.32 to 0.46, P < 0.00001; Irrational dosage: RR = 0.48, 95% CI of 0.39 to 0.57, P < 0.00001; Irrational route of administration: RR = 0.39, 95% CI of 0.33 to 0.47, P < 0.00001). Conclusion: Pharmacy service intervention has a better application effect in patients with dyslipidemia, which can effectively improve the lipid index and medication, reduce the incidence of adverse drug reactions, and improve the safety and reasonableness of patients’ medication.