地中海贫血造血干细胞移植患儿霉酚酸药时曲线下面积及药物不良反应影响因素分析  

Factors influencing the area under the concentration-time curve of mycophenolic acid and adverse drug reactions in children with thalassemia after hematopoietic stem cell transplantation

作　　者：牛露露 伍云 黄天敏 吴廷庆 肖洋 刘滔滔[1] NIU Lu-lu;WU Yun;HUANG Tian-min;WU Ting-qing;XIAO Yang;LIU Tao-tao(Department of Pharmacy,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021)

机构地区：[1]广西医科大学第一附属医院药学部,南宁530021

出　　处：《中南药学》2024年第2期526-531,共6页Central South Pharmacy

摘　　要：目的探讨地中海贫血造血干细胞移植儿童患者霉酚酸(MPA)药时曲线下面积(AUC)及发生药品不良反应(ADR)的影响因素。方法收集我院2022年10月至2023年4月行造血干细胞移植术并监测MPA血药浓度的地中海贫血儿童患者临床资料。采用高效液相色谱法测定血浆MPA浓度并计算其AUC,统计患者用药期间发生ADR的信息。多元回归方法分析MPA-AUC影响因素,同时探究ADR与MPA-AUC及患者生理指标之间的相关性。结果白蛋白(ALB)是MPA-AUC的独立影响因素(P<0.05),ALB水平<35 g·L^(-1)时,患儿AUC最低,提示低蛋白血症对MPA-AUC有影响;并且患儿缺乏肝肠循环,故MPA-AUC偏低。患儿用药后ADR发生率为84.2%,以感染为主。多元回归分析显示:年龄与ADR的发生有相关性(P<0.05)。结论ALB以及缺乏肝肠循环对MPA-AUC有影响;患儿ALB<35 g·L^(-1)时应适当增加给药剂量。患儿用药后ADR发生率较高,年龄是其主要影响因素,有必要进行治疗药物监测,实现精准用药。Objective To determine the factors influencing the area under the concentration-time curve(AUC)of mycophenolic acid(MPA)and the occurrence of adverse drug reactions(ADR)in children with thalassemia after hematopoietic stem cell transplantation(HSCT).Methods Clinical data were collected from pediatric patients with thalassemia after HSCT with monitoring of MPA blood levels from October 2022 to April 2023 in our hospital.The plasma MPA was measured by high-performance liquid chromatography.The MPA-AUC was calculated and information on the occurrence of ADR during the patients’medication was recorded.Multiple regression analysis was used to analyze the factors affecting MPA-AUC and to determine the correlation between ADR and MPA-AUC and the patients’physiological indicators.Results Albumin(ALB)was an independent influence on MPA-AUC in children with thalassemia undergoing HSCT(P<0.05).The lowest AUC was observed in children with an ALB level<35 g·L^(-1),suggesting that hypoproteinemia might affect MPA-AUC,and the lack of hepatic and intestinal circulation in the children resulted in low MPA-AUC.The incidence of ADR in children after the medication was 84.2%,mainly infections.Multiple regression analysis showed a correlation between age and the occurrence of ADR(P<0.05).Conclusion ALB and lack of hepatic and intestinal circulation affect MPA-AUC.Dose should be increased appropriately for children with ALB<35 g·L^(-1).The incidence of ADR after drug administration is fairly high in children,and age is the main influencing factor.Therapeutic drug monitoring is necessary.

关 键 词：造血干细胞移植 地中海贫血 药时曲线下面积 霉酚酸 影响因素 

分 类 号：R969.3[医药卫生—药理学]