隐球菌脑膜炎患者伏立康唑脑脊液浓度与血液浓度的临床分析  

Clinical Analysis of Voriconazole Concentrations in Cerebrospinal Fluid and Blood in Patients with Ryptococcal Meningitis

作　　者：肖桂荣[1] 刘真真[2] 唐光敏[2] XIAO Gui-rong;LIU Zhen-zhen;TANG Guang-min(Department of Clinical Pharmacy,West China Hospital,Sichuan University,Chengdu 610041,China;Center of Infectious Diseases,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院临床药学部(药剂科),成都610041 [2]四川大学华西医院感染性疾病中心,成都610041

出　　处：《四川大学学报（医学版）》2023年第1期192-197,共6页Journal of Sichuan University(Medical Sciences)

基　　金：四川省科技计划(No.2020YFS0138、No.2020YFQ0010)资助。

摘　　要：目的探索伏立康唑在隐球菌脑膜炎患者中枢神经系统的分布浓度及其关系。方法回顾性分析25例非HIV感染的隐球菌脑膜炎成人患者的伏立康唑脑脊液谷浓度与血液谷浓度,并探索影响脑脊液/血液浓度比值的患者因素。结果伏立康唑血液谷浓度范围0.38~8.56 mg/L,中位数(P_(25),P_(75))为1.81(1.40,3.84)mg/L。伏立康唑脑脊液谷浓度范围0.17~3.92 mg/L,中位数(P_(25),P_(75))为1.02(0.54,1.84)mg/L。伏立康唑脑脊液浓度与脑脊液有核细胞数呈负相关,但无统计学意义(r=-0.377,P=0.063)。伏立康唑脑脊液浓度与血液浓度呈正相关(r=0.736,P<0.001),脑脊液/血液浓度比值中位数(P_(25),P_(75))为0.43(0.34,0.68)。脑脊液/血液浓度比值与年龄、体表面积、影像学改变(脑积水)或颅内压无关。结论伏立康唑脑脊液浓度与血液浓度呈正相关,且未发现影响其比值的因素。Objective To investigate the concentrations of voriconazole(VCZ)in the central nervous system(CNS)of patients with cryptococcal meningitis and the relationship thereof.Methods We retrospectively analyzed the trough concentration of VCZ in the cerebrospinal fluid(CSF)and the blood of 25 adult patients who had cryptococcal meningitis,and who were not infected with HIV.We also examined patient-level characteristics that could contribute to the differences in CSF/plasma VCZ concentration ratio.Results The trough concentration of VCZ in plasma ranged from 0.38 to 8.56 mg/L,and the median(P_(25),P_(75))was 1.81(1.40,3.84)mg/L.The trough concentration of VCZ in CSF ranged from 0.17 to 3.92 mg/L,and the median(P_(25),P_(75))was 1.02(0.54,1.84)mg/L.The CSF VCZ trough concentration showed a slight negative correlation with the nucleated cell counts in CSF,but the correlation was not statistically significant(r=-0.377,P=0.063).There was a positive correlation between VCZ concentrations in CSF and that in the plasma(r=0.736,P<0.001),and the median(P_(25),P_(75))CSF/plasma ratio was 0.43(0.34,0.68).The CSF/plasma ratio did not statistically correlate with age,body surface area(BSA),radiology changes(hydrocephalus),or intracranial pressure.Conclusion There is a positive correlation between VCZ concentration in CSF and VCZ concentration in the plasma,and no influencing factors of CSF/plasma ratio were found.

关 键 词：伏立康唑 隐球菌 脑脊液 脑脊液/血液浓度比值 影响因素 

分 类 号：R519[医药卫生—内科学]