319例次儿童霉酚酸血药浓度监测结果分析  

Analysis of 319 Case-times of Blood Concentration Monitoring of Mycophenolic Acid in Pediatric Patients

作　　者：王广飞[1] 李琴[1] 朱逸清[1] 陈也伟[1] 朱琳[1] 张旭晖[1] 卢金淼[1] 李智平[1] Wang Guangfei;Li Qin;Zhu Yiqing;Chen Yewei;Zhu Lin;Zhang Xuhui;Lu Jinmiao;Li Zhiping(Department of Clinical Pharmacy, Children＇ s Hospital of Fudan University, Shanghai 201102, China)

机构地区：[1]复旦大学附属儿科医院临床药学部,上海201102

出　　处：《药物流行病学杂志》2018年第6期396-399,共4页Chinese Journal of Pharmacoepidemiology

基　　金：中国世界卫生组织2016-2017双年度合作项目(编号:2016/647672-0);上海市卫生计生系统重要薄弱学科建设项目(编号:2016ZB0305)

摘　　要：目的:分析复旦大学附属儿科医院2016年11月~2017年10月霉酚酸(MPA)血药浓度监测结果,促进临床安全用药。方法:采用酶放大免疫技术测定血清中游离MPA浓度,利用Mwphar^+软件模拟MPA的药动学曲线,计算AUC_(0~12h)值。收集患儿的临床资料,对患儿性别分布、疾病分类、血药浓度监测结果、药品不良反应(ADR)及转归情况进行分析。结果:纳入患儿237例,平均年龄为(10.70±3.61)岁,319例次MPA血药浓度监测结果。涉及到的疾病有14种,主要为系统性红斑狼疮(33.54%),肾病综合征(16.61%)和异体器官移植(15.05%)。MPA-AUC0~12h值在30~60 mg·h·L^(-1)的患儿约占48.28%。ADR主要涉及胃肠道(13.79%),所有发生ADR的患儿症状好转或消失。结论:结合Mwphar+软件拟合AUC代谢曲线,可更好地掌握患儿体内MPA的暴露量,提高临床疗效,保障儿童安全用药。Objective：Mycophenolic acid （MPA） therapeutic drug monitoring （TDM） of pediatric patients from Children＇ s Hospital of Fudan University during November 2016 to October 2017 was analyzed to improve clinical outcomes. Methods：Concentrations of serum MPA were determined by enzyme multiplied immunoassay technique, with the Mwphar＋ software applied for the pharmacokinetic curve-fitting analysis and calculation of the MPA - area under the concentration- time curve （MPA-AUC0-12h） based on the patients＇ physiological conditions. The clinical data were collected, alter which the patients＇ gender, disease spectrum, MPA-AUC0-12h, adverse drug reactions（ADR） and outcomes were analyzed. Re- suits： A total of 237 pediatric patients treated by MMF participated in the study, with the average age at （10.70 ± 3.61 ） years. The study included 319 case-times of MPA TDM, and involved 14 diseases, in which systemic lupus erythematosus making the most proportion （33.54%）, followed by nephrotic syndrome （16.61% ） and allogeneic organ transplantation （ 15.05% ）. Of the 319 case-times of MPA TDM, 48.28% of MPA exposure AUC0-12h was 30-60 mg · h ·L-1. The gastrointestinal adverse effects were the most prevalent ADR, with a rate of 13.79%. All the patients with ADR were improved or recovered. Conclusion：When using MMF treating immune system diseases in pediatric patients, close attention must be paid. The Mwphar＋ software is useful for the MPA pharmacokinetic curve-fitting analysis, providing more accurate MPA exposure data, so as to improve clinical outcomes and ensure medication safety.

关 键 词：吗替麦考酚酯 霉酚酸 治疗药物监测 曲线下面积 药品不良反应 

分 类 号：R969.1[医药卫生—药理学]