9389例次环孢素治疗药物监测结果及影响因素分析  

Analysis of 9389 Cases of Cyclosporine A Therapeutic Drug Monitoring Data and Their Influencing Factors

作　　者：陈秀云[1] 林秋雄[1] 侯兴华[1] 何国东 张梦珍[1] 李汉平[1] 杨敏[1] CHEN Xiu-yun;LIN Qiu-xiong;HOU Xing-hua;HE Guo-dong;ZHANG Meng-zhen;LI Han-ping;YANG Min(Research Center of Medical Sciences,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省人民医院医学研究部、广东省医学科学院,广州510080

出　　处：《循证医学》2020年第3期169-173,共5页The Journal of Evidence-Based Medicine

基　　金：2015广州市科技计划资助项目(201509010012)。

摘　　要：目的评价广东省人民医院2014年1月至2017年12月的9389例/次环孢素(cyclosporine A,CsA)治疗药物监测和临床用药情况。方法对广东省人民医院1719例患者9389次的CsA监测结果进行统计分析,并对501例血液病患者的性别、年龄、肝功能、合并用药变化对CsA血药浓度影响的分析。结果首次治疗药物监测结果在有效治疗窗内的仅占30.8%;治疗药物监测次数为1、2、3和大于10次者分别占总人数的41.0%、16.9%、9.2%和14.4%;在所有监测次数为3~5次的患者中,第1、2、3、4、5次治疗药物监测结果在治疗窗内的分别占总人数的38.8%、38.9%、39.2%、37.1%、47.1%;性别、肝功能、合并用药变化对CsA血药浓度均有显著的影响(P<0.05),年龄对CsA血药浓度未有显著影响(P>0.05)。结论治疗药物监测虽然广泛应用,但监测次数偏少;即使监测多次,达标情况仍不理想,应高度重视这种不能很好调整患者用药的现象,这可能与CsA血药浓度药动学参数个体差异和受多种因素影响有关。Objective To evaluate 9389 cases of therapeutic drug monitoring(TDM)and the clinical drug usage of cyclosporine A(CsA)in Guangdong Provincial People's Hospital during January 2014 to December 2017.Methods Analysis and statistics of CsA TDM data of 9389 cases(1719 subjects)in Guangdong Provincial People's Hospital were carried out.The effects of gender,age,liver function and changes of combined medication on the blood concentration of CsA in 501 patients with hematological disease were analyzed.Results Among all the first TDM concentration,only 30.8%was within the therapeutic window.Constituent ratio of patients whose drug concentrations were monitored once,twice,three times or more than ten times respectively of 41.0%,16.9%,9.2%and 14.4%.Among all the subjects undergoing 3~5 times of TDM,constituent ratio of patients whose drug concentrations of the first,second,third,fourth and fifth monitoring were within the therapeutic window accounted for 38.8%,38.9%,39.2%,37.1%and 47.1%respectively.Gender,liver function,and changes of combined medication had significant effect on the blood concentration of CsA(P<0.05),and age had no significant effect on the blood concentration of CsA(P>0.05).Conclusion Although TDM was widely used,the TDM times were insufficient.Even TDM was multiple,the status of which was not satisfactory.We should pay much more attention to the phenomenon that the patients'medication was not adjusted properly.It may correlate with the individual difference of pharmacokinetic parameters of CsA,and many factors that can affect the concentration of CsA.

关 键 词：治疗药物监测 环孢素 治疗窗 构成比 影响因素 

分 类 号：R969.3[医药卫生—药理学]