药学学报, 2018, 53(1): 104-110
引用本文:
高玉成, 焦正, 黄虹, 谢晨, 高建军, 张亮, 方洁, 林玮玮, 刘艺茜, 宫晔. 万古霉素个体化给药决策支持系统的研制[J]. 药学学报, 2018, 53(1): 104-110.
GAO Yu-cheng, JIAO Zheng, HUANG Hong, XIE Chen, GAO Jian-jun, ZHANG Liang, FANG Jie, LIN Wei-wei, LIU Yi-xi, GONG Ye. Development of decision system for individualization of vancomycin dosage[J]. Acta Pharmaceutica Sinica, 2018, 53(1): 104-110.

万古霉素个体化给药决策支持系统的研制
高玉成1, 焦正1, 黄虹2, 谢晨3, 高建军3, 张亮1, 方洁4, 林玮玮5, 刘艺茜1,6, 宫晔7
1. 复旦大学附属华山医院药剂科, 上海 200040;
2. 复旦大学附属华山医院信息科, 上海 200040;
3. 微软(中国)有限公司, 上海 200030;
4. 上海交通大学医学院附属瑞金医院药剂科, 上海 200025;
5. 福建医科大学附属第一医院药学部, 福建 福州 350005;
6. 中国药科大学基础医学与临床药学学院, 江苏 南京 211198;
7. 复旦大学附属华山医院危重病科, 上海 200040
摘要:
万古霉素是目前治疗耐甲氧西林的金葡球菌感染的一线用药。因其药动学存在较大的个体差异,给药方案需要个体化。本研究通过系统检索,收集中国人群的万古霉素群体药动学特征参数,结合R语言rjags包的最大后验贝叶斯算法,研制了万古霉素的个体化给药决策辅助系统"SmartDose"。该系统可针对普通成人以及新生儿、老年人、神经外科患者等特殊人群,制定个体化的万古霉素给药方案。系统功能包括制定初始方案、根据治疗药物监测结果调整方案,以及自定义用药方案等。系统算法可靠,与金标准NONMEM软件相比无显著差异。同时,SmartDose为基于Web的应用系统,适用面广,为万古霉素的个体化用药提供了有力的工具。
关键词:   
Development of decision system for individualization of vancomycin dosage
GAO Yu-cheng1, JIAO Zheng1, HUANG Hong2, XIE Chen3, GAO Jian-jun3, ZHANG Liang1, FANG Jie4, LIN Wei-wei5, LIU Yi-xi1,6, GONG Ye7
1. Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200040, China;
2. Department of Medical Information, Huashan Hospital, Fudan University, Shanghai 200040, China;
3. Microsoft Corporation, Shanghai 200030, China;
4. Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China;
5. Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China;
6. School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198, China;
7. Department of Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
Abstract:
Vancomycin has been widely prescribed as the first-line antibiotic in the treatment of methicillin-resistant Staphylococcus aureus and other serious Gram-positive infections. Due to its large pharmacokinetic (PK) variability and narrow therapeutic range, it requires optimization of dosage to achieve target exposure. In this study, SmartDose, a decision support system for individualization of vancomycin dosage is developed using the maximum a posterior Bayesian estimation (MAPB) by the open-source language R combined with the population PK characteristics of vancomycin in Chinese patients. It provides initial design and adjustment of dose regimens based on the therapeutic drug monitoring (TDM) results, as well as a user-defined module to facilitate optimal vancomycin therapy. SmartDose has a high computational reliability, which is validated by NONMEM, the golden standard PK software. Meanwhile, SmartDose is established as a web-based application and its operational flexibility makes it an efficient tool for vancomycin dose optimization in routine clinical settings.
Key words:   
收稿日期: 2017-07-11
DOI: 10.16438/j.0513-4870.2017-0673
基金项目: 国家自然科学基金资助项目(81573505);上海卫生计生系统重要薄弱学科建设计划资助项目(2016ZB0301-01,2016ZB0202-01).
通讯作者: 焦正,Tel:86-21-52888712,E-mail:zjiao@fudan.edu.cn
Email: zjiao@fudan.edu.cn
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