高剂量氟康唑治疗肥胖患者肺隐球菌病的药学实践  

High-dose fluconazole for an obese patient with pulmonary cryptococcosis

作　　者：袁亚平 刘婷婷 吴炯熇[1,2] 方向群 姜学革[2] 汤智慧[3] 李洪霞[2] YUAN Ya-ping;LIU Ting-ting;WU Jiong-he;FANG Xiang-qun;JIANG Xue-ge;TANG Zhi-hui;LI Hong-xia(Chinese PLA Medical School,Beijing 100853;Department of Respiratory and Critical Care Medicine,The Second Medical Center,National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853;Department of Pharmacy,the Medical Supplies Center,Chinese PLA General Hospital,Beijing 100853)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第二医学中心呼吸与危重症医学科,国家老年疾病临床医学研究中心,北京100853 [3]解放军总医院医疗保障中心药剂科,北京100853

出　　处：《中南药学》2023年第1期253-258,共6页Central South Pharmacy

基　　金：国家重点研发计划项目(No.2020YFC2005402);军委后勤保障部卫生局应用基础研究项目(No.20BJZ28)。

摘　　要：通过高剂量氟康唑治疗1例免疫功能正常肥胖患者的药学实践,探索肺隐球菌病的个体化治疗。治疗过程中应用影像组学技术评估病灶变化,疗效不佳时根据药代动力学/药效动力学(PK/PD)调整氟康唑剂量,同时监测药物不良反应。1年后患者病灶大部分吸收,未出现明显药物不良反应。提示临床,肺隐球菌病肥胖患者可能需要更高剂量的氟康唑,治疗过程中应监测其血药浓度,并推算0~24 h浓度时间曲线下药物面积(AUC)与最小抑菌浓度(MIC)的比值(AUC_(0~24 h)/MIC),以保证疗效。病灶明显吸收后再逐渐减量。To explore the individualized treatment of pulmonary cryptococcosis by high dose fluconazole in an immunocompetent obese patient.Radiomics was used to assess the lesion changes during the treatment.The therapeutic dose of fluconazole was adjusted according to its pharmacokinetics/pharmacodynamics(PK/PD)when the efficacy was not good.The side effects were monitored throughout the treatment.One year later,most of the lesions disappeared and no obvious side effects were observed in this patient,suggesting that obese patients with pulmonary cryptococcosis might need higher dosages of fluconazole.The serum drug concentration should be monitored during the treatment,and the ratio of area under the concentration-time curve(AUC_(0~24 h))to minimum inhibitory concentration(MIC)(AUC_(0~24 h)/MIC)should be calculated to ensure the curative effect.After obvious absorption of the lesions,the dosage can be gradually reduced.

关 键 词：肺隐球菌病 氟康唑 血药浓度 PK/PD 影像组学技术 

分 类 号：R969.3[医药卫生—药理学]