构建中药上市后安全性评价证据体的思考

摘要

Safety surveillance is the most important aspect for post-marketing research of Chinese medicine.However,passive monito-ring systems or phase four clinical trials or large sample epidemiology studies were historically the common ways of surveillance of post-marketing Chinese medicine.However those studies can no longer meet the expectations,and there are many more evidence sources for post-marketing Chinese medicine safety evaluation,eg.active surveillance from observational cohort study and study on hospital informa-tion system.These data and study can provide adequate source data for post-marketing Chinese medicine research.The most prominent problem is how to integrate different evidences from multiple sources.This article suggests we should build an evidence-based system to evaluate post-marketing Chinese medicines safety.%中药上市后安全性评价关乎用药患者在临床应用中的生命安全，关系着国家医疗卫生政策的导向，以及药厂对药品开发规划设计。上市后药品的安全监测无疑是所有上市后药品的重要内容，而监测主要关注药品在上市前未曾发现的那些潜在的不良反应/事件。既往，上市后药物监测习惯以被动监测模式或者是四期的临床试验或者是大型的流行病学调查，这些统被称之为安全性监测或药物警戒研究。现今，研究者们发现这些方法或方式远远不能满足当下对于上市后药品安全性评价的证据需求。为此，为了能够弥补这些证据积累的不足，目前亟需发展新的证据研究模式，比如转向大样本大范围的主动监测，采用队列观察性研究方法，基于真实世界医疗电子数据库等等。本文基于上市后中药的特点，从循证医学证据理念出发，提出构建中药上市后安全性评价证据体的设想来对未来中药上市后安全性评价研究提供参考。