Pharmacotherapy:QTc间期风险预测模型可否预测QTc间期延长风险?

2018-09-07 吴星 环球医学

2018年8月,发表于《Pharmacotherapy》上的一项系统评价,对存在QT间期延长风险患者进行预测分析。

2018年8月,发表于《Pharmacotherapy》上的一项系统评价,对存在QT间期延长风险患者进行预测分析。

心率校正QT(QTc)间期延长会增加尖端扭转型室性心动过速(TdP),这是一种潜在的致命性心律失常。TdP的发生率在女性、高龄、射血分数降低的心衰、低钾血症、低镁血症、同时服用两种或两种以上QTc延长药物等危险因素的患者中更高。风险因素的评估和量化可能有助于预测进展至QTc间期延长和TdP的风险最高的患者。研究人员利用预测分析领域,即采用数据挖掘、建模、机器学习等技术进行预测,并开发出QTc间期延长的风险量化和预测方法。预测分析还被纳入临床决策支持(CDS)工具,以提醒医生有关QTc间期延长风险增加的患者。本文旨在评估预测分析识别存在药物导致的QTc间期延长风险患者的有效性,并讨论在临床实践中将预测分析纳入到CDS工具的有效性。

对英文文章(仅人体研究)开展系统评价,产生57篇文章,额外4篇文章是从其他来源识别的;10篇文章被纳入本综述。QTc间期延长的风险得分已在不同患者人群中建立,包括心脏重症监护病房(ICUs)和住院或健康系统患者更广泛人群的。一组开发了一个风险评分,包括关于遗传多态性的信息;这个评分能明显预测TdP。QTc间期风险预测模型的建立和这些模型纳入至CDS工具能降低心脏ICUs中QTc间期延长的风险,并识别出死亡风险增加的健康系统患者。这些QTc间期延长预测分析对总的患者安全结局的影响需要进一下研究,例如TdP和心脏性猝死相对于开发和实施的成本。

原始出处:

Tomaselli, Muensterman E, Tisdale JE. et.al. Predictive Analytics for Identification of Patients at Risk for QT Interval Prolongation: A Systematic Review. Pharmacotherapy. 2018 Aug;38(8):813-821. doi: 10.1002/phar.2146. Epub 2018 Jul 18.

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    2019-05-04 jj000001
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    2019-03-01 yb6560
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    2018-09-12 醉半生

    很好

    0

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    2018-09-07 CHANGE

    梅斯里提供了很多疾病的模型计算公式,赞一个!

    0

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