伏立康唑治疗重度肝硬化患者侵袭性真菌感染的研究进展  

Advances in voriconazole for the treatment of invasive fungal infections in patients with severe liver cirrhosis

作　　者：冯飞飞 朱莺莺[2] FENG Feifei;ZHU Yingying(Department of Pharmacy,Taian Central Hospital(Taian Central Hospital Affiliated to Qingdao University,Taishan Medical Nursing Center),Shandong,Taian 271000,China;Department of Critical Care Medicine,Taian Central Hospital(Taian Central Hospital Affiliated to Qingdao University,Taishan Medical Center),Shandong,Taian 271000,China)

机构地区：[1]泰安市中心医院(青岛大学附属泰安市中心医院、泰山医养中心)药学部,山东泰安271000 [2]泰安市中心医院(青岛大学附属泰安市中心医院、泰山医养中心)重症医学科,山东泰安271000

出　　处：《中国医药科学》2023年第20期37-40,共4页China Medicine And Pharmacy

摘　　要：肝硬化患者由于机体免疫功能降低容易发生真菌感染,伏立康唑是具有广谱抗真菌活性的三唑类化合物,可用于治疗念珠菌属、曲霉菌属、足放线菌属和镰刀菌属引起的真菌感染。目前伏立康唑用于轻度到中度肝硬化患者(Child-Pugh A和B),推荐负荷剂量不变,维持剂量减半,对重度肝硬化(Child-Pugh C)患者的用法用量尚未明确,相关的循证医学证据不足,本文结合国内外文献报道,分析重度肝硬化患者使用伏立康唑的肝毒性和用法用量,为临床提供合理的用药方案。建议对于严重肝功能不全的患者应权衡利弊使用伏立康唑,可给予负荷剂量不变,维持剂量为正常肝功能的1/3或1/4,并建议给予血药浓度监测,依据血药浓度监测结果调整治疗方案。Patients with cirrhosis are susceptible to fungal infections due to the reduced immune function of the body.Voriconazole is a triazole compound with broad-spectrum antifungal activity for the treatment of fungal infections caused by Candida,Aspergillus,Actinomyces and Fusarium spp.Currently,voriconazole is used in patients with mild to moderate cirrhosis(Child-Pugh A and B)with the recommended loading dose unchanged and the maintenance dose reduced by half.However,the dosage for patients with severe cirrhosis(Child-Pugh C)has not been clarified and there is insufficient evidence-based medical evidence for this.This paper analyzes the hepatotoxicity and dosage of voriconazole in patients with severe liver cirrhosis,taking into account reports in the domestic and international literature,and provides a reasonable dosing plan for clinical use.It is recommended that voriconazole should be used on balance in patients with severe hepatic insufficiency and may be given at a constant loading dose and a maintenance dose of one third or one quarter of the normal liver function.It is also recommended that blood levels be monitored and that the treatment regimen be adjusted based on the results of the blood level monitoring.

关 键 词：伏立康唑 重度肝硬化 侵袭性真菌感染 血药浓度监测 维持剂量 

分 类 号：R575.2[医药卫生—消化系统]