血药浓度监测与伏立康唑致肝损伤的发生情况及影响因素分析  

Incidence and risk factors of voriconazole-induced liver injury in the context of therapeutic drug monitoring

作　　者：林良沫[1] 洪绵慧 吴丹娜[1] 钟莉莉[1] 符祥俊[2] LIN Liangmo;HONG Mianhui;WU Danna;ZHONG Lili;FU Xiangjun(Department of Pharmacy,Hainan General Hospital,Affiliated Hospital of Hainan Medical University,Haikou 570311,China)

机构地区：[1]海南省人民医院(海南医学院附属海南医院)药学部,海口570311 [2]海南省人民医院(海南医学院附属海南医院)血液内科,海口570311

出　　处：《中国感染与化疗杂志》2023年第6期709-714,共6页Chinese Journal of Infection and Chemotherapy

基　　金：海南省自然科学基金(822QN452)。

摘　　要：目的 分析海南省人民医院临床使用伏立康唑致肝损伤的发生情况,探索可能的影响因素。方法 将研究期间使用伏立康唑并接受血药浓度监测且起始肝功能正常的患者纳入研究,根据用药后肝功能检查结果将患者分为未发生肝损伤组和发生肝损伤组。采用单因素及二元logistic回归分析伏立康唑致肝损伤的危险因素,并使用受试者工作特征(ROC)曲线确定各个危险因素预测性能的灵敏度、特异度和最佳截点。结果 共有116例患者纳入研究,肝损伤发生率为28.4%。单因素和多因素分析结果显示血药谷浓度及感染指标C反应蛋白(CRP)是伏立康唑致肝损伤的危险因素,血药谷浓度>4.80mg/L及CRP>127.86 mg/L的患者肝损伤风险显著增加。结论 对于CRP较高的患者使用伏立康唑期间应当密切监测血药浓度以降低肝损伤风险。Objective To investigate the incidence of voriconazole-induced liver injury and the possible risk factors in the context of therapeutic drug monitoring(TDM).Methods The patients receiving voriconazole treatment and therapeutic drug monitoring and with normal initial liver function were enrolled.The patients were assigned to liver injury group or no liver injury group according to the liver function tests during voriconazole treatment.Univariate analysis and binary logistic regression were used to analyze the risk factors of liver injury.Receiver operating characteristic(ROC)curve was used to analyze the specificity,sensitivity and the best cut-off value of the risk factors in predicting the occurrence of liver injury.Results The incidence of voriconazoleinduced liver injury was 28.4%in the 116 enrolled patients.Univariate and multivariate analyses showed that trough concentration and C-reactive protein(CRP)were the risk factors of voriconazole-induced liver injury.The risk of liver injury increased significantly when trough concentration>4.80 mg/L and/or CRP>127.86 mg/L.Conclusions The patients with high CRP level should be followed up by TDM during voriconazole treatment in order to reduce the risk of liver injury.

关 键 词：伏立康唑 肝损伤 血药浓度监测 

分 类 号：R978.5[医药卫生—药品]