274例结核病患者抗结核药物血药浓度分析及其药物安全性探究  

Analysis of blood concentration of anti-tuberculosis drugs and exploration of drug safety in 274 tuberculosis patients

作　　者：张冰 西娜 陈明[1] 赵冠人[1] ZHANG Bing;XI Na;CHEN Ming;ZHAO Guan-ren(Department of Pharmacy,Medical Supplies Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院医疗保障中心药剂科,北京100853

出　　处：《中国药物应用与监测》2023年第2期90-94,共5页Chinese Journal of Drug Application and Monitoring

基　　金：北京市科技计划项目(Z141107002514023)。

摘　　要：目的:监测结核病患者抗结核药物的血药浓度并对结果及其安全性进行分析。方法:回顾性分析274例结核病患者使用一线抗结核药物治疗后的血药浓度监测结果以及用药前后相关指标变化情况。结果:使用异烟肼、利福平、吡嗪酰胺、乙胺丁醇和左氧氟沙星的患者分别有54.45%、46.38%、47.96%、61.50%和22.22%血药浓度达到治疗窗;异烟肼的血药浓度对ALT有显著影响(P<0.05),乙胺丁醇的血药浓度对尿酸水平有显著影响(P<0.05)。异烟肼与利福平联用血药浓度对ALT、AST、肌酐、尿素氮和尿酸均无显著影响。结论:抗结核一线治疗药物的血药浓度达标率普遍较低,大部分抗结核药物的血药浓度达到治疗窗并未使不良反应显著增加。但应关注异烟肼和乙胺丁醇对ALT和尿酸水平的影响。Objective:To monitor the blood concentration of anti-tuberculosis drugs in tuberculosis(TB)patients and explore the safety of them.Methods:Data of therapeutic drug monitoring of the first-line anti-tuberculosis drugs in 274 TB patients and the changes of related indexes before and after therapy were analyzed retrospectively.Results:Blood concentration of isoniazid,rifampicin,pyrazinamide,ethambutol and levofloxacin reached the therapeutic window in 54.45%,46.38%,47.96%,61.50%and 22.22%of patients,respectively.The level of alanine aminotransferase(ALT)and uric acid changed significantly with the blood concentration of isoniazid and ethambutol,respectively(P<0.05).The level of ALT,aspartate aminotransferase(AST),creatinine,urea nitrogen,and uric acid did not change significantly with the blood concentration of anti-tuberculosis drugs when using isoniazid combined with rifampicin.Conclusion:The rate of the first-line anti-tuberculosis drugs with the target blood concentration was generally low.And there was no significant increase in adverse drug reactions for the most anti-tuberculosis drugs with the target blood concentration.However,attention should be paid to the effects of isoniazid and ethambutol on ALT and uric acid respectively.

关 键 词：结核病 抗结核药物 血药浓度 药品不良反应 

分 类 号：R917[医药卫生—药物分析学] R978.3[医药卫生—药学]