呼吸科伏立康唑药物浓度的影响因素及监测意义  

Influence Factors and Monitoring Significance of Voriconazole Concentration in the Respiratory Department

作　　者：汪静 苏涌[2] 冯丽娟[2] 王鑫铭[2] 许杜娟[1,2] WANG Jing;SU Yong;FENG Lijuan;WANG Xinming;XU Dujuan(College of Pharmacy,Anhui Medical University,Hefei,Anhui,China 230022;Department of Pharmacy,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui,China 230022)

机构地区：[1]安徽医科大学药学院,安徽合肥230022 [2]安徽医科大学第一附属医院药剂科,安徽合肥230022

出　　处：《中国药业》2022年第10期55-59,共5页China Pharmaceuticals

基　　金：国家自然科学基金青年科学基金[82104185];吴阶平医学基金会临床科研专项资助基金[320.6750.2020-04-39]。

摘　　要：目的为优化伏立康唑的临床应用提供参考。方法选取2019年7月至2021年5月医院呼吸科收治的使用伏立康唑治疗的患者385例,根据是否进行治疗药物监测(TDM)分为TDM组(n=92)及非TDM组(n=293),TDM组在治疗期间监测了伏立康唑谷浓度(C_(min)),并根据监测结果调整给药剂量。比较两组患者的临床结局,并分析TDM组患者C_(min)与临床疗效和安全性的关系,以及影响因素。结果TDM组有效率为79.35%,显著高于非TDM组的61.43%(P=0.002);肝毒性发生率为3.26%,显著低于非TDM组的9.90%(P=0.044);伏立康唑的治疗效果与C_(min)密切相关,年龄、天门冬氨酸氨基转移酶、超敏C反应蛋白、总胆固醇、三酰甘油、低密度脂蛋白水平及是否合用质子泵抑制剂(PPIs)是C_(min)的影响因素。结论在呼吸科患者中,特别是针对高龄,肝损伤,炎性水平、血脂较高及合并使用PPIs的患者,开展伏立康唑的TDM可提高疗效和安全性。Objective To provide a reference for optimizing the clinical application of voriconazole.Methods A total of 385 patients treated with voriconazole in the respiratory department of the hospital from July 2019 to May 2021 were selected and divided into the therapeutic drug monitoring(TDM)group(n=92)and non-TDM group(n=293)according to whether TDM was carried out.The valley concentration of voriconazole(C_(min))was monitored in the TDM group during the treatment,and the dosage was adjusted according to the monitoring results.The clinical outcomes of the two groups were compared.In the TDM group,the relationship between C_(min) and clinical efficacy or safety was analyzed,as well as the influencing factors of C_(min).Results The effective rate in the TDM group was 79.35%,which was significantly higher than 61.43%in the non-TDM group(P=0.002).The incidence of hepatotoxicity in the TDM group was 3.26%,which was significantly lower than 9.90%in the non-TDM group(P=0.044).The therapeutic effect of voriconazole was closely related to C_(min).Age,aspartate aminotransferase(AST),high-sensitivity C-reactive protein(hs-CRP),total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein(LDL-C)and whether proton pump inhibitors(PPIs)were combined were the influencing factors of C_(min).Conclusion TDM of voriconazole can improve the efficacy and safety in patients in the respiratory department,especially those with advanced age,liver injury,high inflammatory level,high blood lipid and combined use of PPIs.

关 键 词：伏立康唑 治疗药物监测 呼吸科 临床结局 影响因素 

分 类 号：R969.3[医药卫生—药理学] R978.5[医药卫生—药学]