层次分析法对抗抑郁药物进行风险效益评价

发布时间：2018-03-24 03:37

本文选题：层次分析法　切入点：米氮平　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:本研究采用层次分析法(AHP)对四种抗抑郁药物(米氮平、文拉法辛、西酞普兰和舍曲林)进行风险效益评价,运用AHP法建立药物优选模型,得出各个药物的效益值,风险值,综合评分值并进行排序,对抑郁症治疗的四种药物进行优选,为临床合理用药提供帮助。方法:(1)建立层次结构模型,确定目标层、准则层和方案层。总目标为拟解决的问题,本研究将抗抑郁药物的优选作为决策总目标;准则层则是为实现总目标而采用的指标,能充分反映抗抑郁药物的安全性和有效性,本研究分别采用药物的2周起效率、6周有效率和常见不良反应发生数量、常见不良反应发生严重程度;方案层,即用于解决问题的备选方案,选择目前临床常见的四种抗抑郁药物,分别是米氮平、文拉法辛、西酞普兰和舍曲林。(2)目标图建立以后,构建对比矩阵,使用1-9评分法确定各个属性的相对重要性,对准则层的各指标之间,以及方案层对准则层之间,进行两两比较并进行指标赋权和矩阵计算,得出各方案的风险值,效益值和综合评分。(3)判断矩阵的一致性检验。(4)敏感性分析,使用Expert Choice软件进行敏感性分析。结果:通过计算机检索系统查找相关数据库,找出待评价药物近年来的相关Meta分析文献,通过Meta分析中有关起效率、有效率和不良反应的结果,对层次结构模型中的各属性之间进行两两比较和矩阵计算,得出米氮平、文拉法辛、西酞普兰和舍曲林的综合评分值分别为0.277、0.273、0.223和0.227。效益值分别为0.313、0.313、0.313、0.063。风险值分别为0.196、0.282、0.354和0.169。各层次的判断矩阵的一致性比率(CR)均小于0.1,即都通过了一致性检验。结论:综合评分最高的是米氮平,最低的是西酞普兰。效益值最低的是舍曲林,风险值最高的是西酞普兰。效益指标与风险指标均为该研究的敏感性因素,子标准中的2周起效率可在0.077-0.265之间变动,6周有效率可在0.078-0.262之间变动,常见不良反应发生数量可在0.242-0.314之间变动,常见不良反应发生严重程度可在0.021-0.268之间变动,超出范围会影响四种药物的综合评分排序。
[Abstract]:Objective: to evaluate the risk and benefit of four antidepressants (metozapine, venlafaxine, citalopram and sertraline) by analytic hierarchy process (AHP), and to establish the optimal drug selection model by using AHP method, and to obtain the benefit value of each drug. The risk value, the comprehensive score value and the ranking were used to select the four drugs for the treatment of depression so as to provide help for the rational use of drugs in clinical practice. Methods: 1) to establish a hierarchical structure model and determine the target level. The general objective of this study is to make the optimal selection of antidepressants as the overall decision objective, and the criteria layer is the index to achieve the overall goal, which can fully reflect the safety and effectiveness of antidepressants. In this study, we used the effective rate of 6 weeks and the number of common adverse reactions, the severity of common adverse reactions, the program level, the alternatives for solving the problem, and the effective rate of 6 weeks and the number of common adverse reactions, respectively. Four common antidepressants, namely, metozapine, venlafaxine, citalopram and sertraline, were selected. After the establishment of the target map, a comparison matrix was constructed, and the relative importance of each attribute was determined by 1-9 scoring method. The risk value of each scheme is obtained by comparing the indexes of the criterion layer and the criterion layer by comparing the indicators and calculating the matrix. The sensitivity analysis of benefit value and comprehensive score. 3) the consistency test of judgment matrix. The sensitivity analysis was carried out by using Expert Choice software. Results: the relevant database was searched by computer retrieval system. To find out the relevant Meta analysis literature of the drugs to be evaluated in recent years, through the results of the Meta analysis about the efficiency, the effective rate and the adverse reaction, to carry on the pairwise comparison and the matrix calculation among the attributes in the hierarchical structure model, and to obtain the rice nitrogen level. Venlafaxine, The comprehensive scores of citalopram and sertraline were 0.2770.2730.223 and 0.227.The benefit values were 0.3130.3130.3130.63.The risk values were 0.196 / 0.2820.354 and 0.169respectively. The CRs of the judgement matrix of each level were less than 0.1, that is, they passed the consistency test. The highest score was the rice nitrogen level. The lowest is citalopram, the lowest benefit is sertraline, and the highest risk is citalopram. The effective rate varied from 0.077-0.265 in 2 weeks to 0.078-0.262 in 6 weeks, the number of common adverse reactions varied between 0.242 and 0.314, and the severity of common adverse reactions varied from 0.021 to 0.268. Going beyond the range can affect the overall ranking of the four drugs.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R971

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